RJ 


R16 KanMn    - 


Southern  Branch 
of  the 

University  of  California 

Los  Angeles 

Form  L   1 

61 

R16 


This  book  is  DUE  on  the  last  date  stamped  below 


9 

16  1949 


MAR 


Form  L-9-1 


NUKNAL  MJIIUUL, 

liOS  fl^GHLtHS,  0£1U. 


BY 

FKANCIS  H.  BANKIN,  M.  D. 

PRESIDENT    OP    THE    NEWPORT    MEDICAL    SOCIETY, 

MEMBER  OP  THE  NEWPORT  BOARD  OP   HEALTH, 
FELLOW    OP"  THE    RHODE    ISLAND    MEDICAL    SOCIETY,  ETC. 


;   2  3   fe  7 


NEW   YORK 
D.    APPLETON   AND    COMPANY 

1890 

INN  1904' 


COPTRIOHT,  1890, 

BY  D.   APPLETON  AND  COMPANY. 


LAURA    WOLCOTT     RANKIN, 
THIS    LITTLE    VOLUME     18    REVERENTLY     DEDICATED 

AS   A   FILIAL  TEIBUTE   OF  ADMIRATION  FOE   HEE 
MANY     YEARS     OF     EAENE3T     PHILANTHROPIC     EFFORTS 

TO   ELEVATE   THE 

MORAL   AND  PHYSICAL  WELL-BEING 
OF  THE   YOUNG. 


PREFACE 


THE  strength  and  prosperity  of  a  community 
and  a  nation  are  largely  influenced  by  the  sturdy 
vigor  of  body  and  mind  of  the  adult  population  ; 
and,  as  the  oft-quoted  saying  that  the  child  is  father 
to  the  man  is  true,  and  as  the  vigor  at  maturity  must 
in  a  great  measure  depend  upon  proper  guidance 
during  the  years  of  development,  it  follows  that  it 
is  of  the  utmost  importance  that  parents  should  have 
correct  ideas  on  the  personal  hygiene  and  care  of 
their  children. 

Notwithstanding  that  the  study  of  the  period  of 
infancy  and  adolescence  has  received  especial  atten- 
tion of  late  years,  and  that  mothers  are  realizing  more 
and  more  the  vital  necessity  of  hygienic  observ- 
ances at  this  time  of  life,  the  physician  in  his  round 
of  visits  is  made  aware  of  a  woful  lack  of  knowl- 
edge, or  perhaps  appreciation,  of  the  laws  of  health 
by  mothers  and  by  others  who  have  the  guidance  of 
youth ;  and  he  feels  that  arguments  demonstrating 
the  necessity  of  closely  studying  the  requirements 
of  childhood  can  not  be  too  frequently  presented. 


6  PREFACE. 

This  little  manual,  on  the  care  of  children  from 
the  period  of  infancy  to  the  completion  of  puberty, 
can  not  naturally  be  considered  as  embracing  the 
entire  question  of  the  hygiene  of  childhood,  but  is 
intended  merely  to  awaken  serious  thoughts  in  the 
mind  of  the  mother  relating  to  the  care  of  her  chil- 
dren ;  and  it  is  hoped  that  the  suggestions  herein 
contained  will  afford  practical  aid,  and  enable  her 
to  avoid  numerous  hygienic  sins  of  omission  and 
commission. 

NEWPORT,  R.  I. 


CONTENTS-. 


PAGE 

5 

INTRODUCTION 11 

Death-rate  of  children  and  observance  of  the  laws  of  health. — 
Low  mortality  among  Indian  children. — peductions  from 
Indian  habits  of  life. — Result  of  proper  and  improper 
guidance  during  early  childhood. — Moral  training. — Regu- 
larity of  habits  a  necessity  for  perfect  health. 

DIETARY  DURING  CHILDHOOD 18 

Material  for  healthy  development. — Simplicity  of  food. — Over- 
taxing the  digestive  organs. — Purposes  for  which  food  is 
taken. — Importance  of  a  due  amount  of  carbonaceous  and 
nitrogenous  elements  and  of  mineral  salts. — Necessity  of 
variety  of  food. — Consideration  of  milk,  cereals,  oatmeal, 
sweets,  egg?,  and  meat. — Natural  craving  for  acid  fruit. — 
Articles  of  diet. — Indigestible  food,  pastry,  spices,  tea, 
coffee,  etc. — Abundance  of  food  during  school -days. — 
Regularity  of  meals  and  eating  without  hurry. — Effects  fol- 
lowing errors  in  diet. — Fatigue  affecting  the  appetite. — 
School  lunch. — Indigestion  inducing  catarrh  of  the  upper 
air-passages. — Children  following  their  own  fancies  in  eat- 
ing.— Educating  the  appetite. — Evil  results  of  misguidance 
in  dietary. 

PROTECTION  OF  THE  BODY 39 

Physiological  action  of  cold.— Standard  heat  of  the  body. — 
Animal  heat. — Nerve-force  exhausted,  and  excretory  glands 
of  the  skin  affected  by  cold. — Harmf  ulness  of  short  socks. 
— Dressing  for  effect. — Woolen  and  linen  underclothing. — 
Our  changeable  climate. — Benefits  of  ample  protection, 


8  CONTENTS. 

PAGE 

and  dangers  of  scanty  clothing. — Protection  of  feet  and 
legs. — Draughts. — Effect  of  cold  upon  the  digestion. — Too 
much  clothing. — Overcoats. — Dressing  of  girls. — Night- 
clothing. 

IMPORTANCE  OF  PDRE  AIR 54 

Oxygen  as  food. — Detection  of  impure  air. — Source  of  air 
pollution. — Deleterious  effect  of  impure  air. — Air  of  the 
nursery. — Poisonous  exhalations  from  lungs  and  ekin. — 
House  filth.  —  Micro-organisms. — Ventilation.  —  Catarrhal 
condition. — Breathing  through  the  nose. — Mouth  breath- 
ing.— Its  dangers. — Delicacy  of  frame  the  result  of  modern 
ways  of  life. — Benefits  of  free  ventilation. — How  to  pre- 
serve pure  air  in  the  house. — Damp  cellars. 

EXERCISE  A  REQUIREMENT  FOR  HEALTH 72 

Its  effect. — Result  of  its  neglect. — Combining  physical  and 
mental  training. — Outdoor  games. — Lawn  tennis  for  girls. 
— Exercise  versus  drugs. — Indoor  life  and  its  result. — Out- 
door exercise  in  all  weather. — Growing  pains. — Play-room. 
— Toughening  children. 

SLEEP 80 

Dr.  Hammond  on  sleep  and  rest. — Sleep  during  childhood. — 
Its  duration. — Noonday  nap. — Symptoms  resulting  from 
too  little  sleep. — Its  importance  where  hereditary  weak- 
nesses exist. — Its  effect  upon  the  nervous  system. — Avoid- 
ance of  romping  and  excitement  at  bedtime. — Night  ter- 
pors. — Means  favoring  sleep. 

REGULARITY  OF  THE  BOWELS 86 

Remoral  of  waste  material  from  the  system. — Constipation 
during  school -days. — Causes  of  constipation. — Its  effect 
upon  health  and  method  for  overcoming  the  same. 

CARE  OF  THE  SKIN 90 

Eliminative  function  of  the  skin  and  danger  of  interfering 
with  it. — Baths. — Effects  of  cold  and  warm  baths  and  their 
dangers. — Temperature. — Daily  sponging. — Suggestions  re- 
garding delicate  children. — Friction. — Salt-water  bath. — 
Its  duration. — Wading  or  paddling. 


CONTENTS.  9 

PAGB 

EDUCATION 100 

Increase  of  the  diseases  of  the  nervous  system,  and  causes. — 
Protection  of  the  nervous  system. — Diversion  of  nerve-force 
from  nutrition. — Early  stimulation  of  the  brain. — Age  of 
commencing  school. — Kindergarten. — Precocious  children. 
— Hours  for  exercise  and  sleep  infringed  upon. — Results  of 
overstudy. — Returning  to  school  after  serious  illness. 

SCHOOL  HYGIENE 106 

Loss  of  health  as  a  result  of  defective  school  sanitation. — 
School  lunch. 

DISCIPLINE 108 

Obedience  and  self-control. — Respect  for  elders. — Sugges- 
tions for  inculcating  obedience. — A  physician's  experience. 
— Cause  of  disobedience. 

YGIENIC  REFLECTIONS Ill 

Laws  of  health  as  fixed  as  other  physical  laws. — Herbert 
Spencer  on  children. — Causes  of  degeneracy  of  health. — 
Symptoms  indicative  of  lack  of  physical  vigor. — Hereditary 
tendencies  overcome. 

PUBERTY 115 

History  of  a  case  as  a  text  on  hygiene  during  puberty. — Com- 
parison of  life  to-day  with  the  life  half  a  century  ago. — 
Sins  of  the  parents  visited  upon  the  children. — Indications 
of  approaching  change. — Special  care. — Protection  of  the 
body  and  feet. — Mental  strain. — Sleep. — Nervousness,  its 
indication. — Constipation. — Opinion  of  Dr.  Emmet. — What 
to  avoid  during  the  catamenia. — Bathing  during  the  month- 
ly period. — Absolute  rest  not  intended  by  Nature. — Girl  in 
her  "teens." — Commencing  school  without  breakfast. — 
Combining  school  and  social  duties. 

APPENDIX 137 

Mortuary  statistics  and  deductions  therefrom. 


HYGIENE  OF  CHILDHOOD. 


INTKULuJCTION. 

/  as  to  ? 

UNTIL  within  a  very  recent  date,  nearly  one  half 
of  the  total  mortality  in  the  larger  cities  throughout 
our  country  was  of  children  under  five  years  of  age.* 
This  fact  affords  matter  for  the  deepest  considera- 
tion, and  a  thoughtful  mind  will  naturally  question 
the  reason  of  so  great  a  destruction  of  life  among 
the  young.  Investigation  shows  that  this  large  mor- 
tality  was  mainly  due  to  a  disregard  of  the  laws  of 
health,  and  that  obedience  to  these  laws  will  very 
materially  reduce  the  death-rate.  The  correctness 
of  this  statement  may  be  verified  by  a  study  of  the 
mortuary  statistics  of  large  cities  during  the  past 
fifteen  or  twenty  years,  in  connection  with  the  sani- 
tary reforms  in  these  cities ;  and  also  by  a  compara- 
tive study  of  mortuary  tables  exhibiting  the  differ- 

*  See  Appendix. 


12  HYGIENE  OF  CHILDHOOD. 

ence  in  the  death-rate  among  children  in  large  and 
small  cities,  from  which  tables  it  is  evident  that, 
wherever  the  laws  governing  life  arc  most  carefully 
followed,  there  will  be  found  a  lower  mortality  dur- 
ing early  life.  When  the  death-rate  among  chil- 
dren in  larger  cities  can  be  materially  reduced  by 
improved  general  sanitation,  it  is  obvious  that  the 
health  and  vigor  of  children  in  their  homes  can  also 
be  improved  by  close  attention  to  their  personal 
hygiene. 

It  is  interesting  as  well  as  instructive  to  contrast 
the  death-rate  among  children  living  in  modern 
cities  with  that  among  the  Indians  when  living  in 
their  primitive  state,  before  they  were  contaminated 
by  the  vices  of  the  white  man.  Catlin,  an  earnest 
student  of  the  customs  and  habits  of  the  Indian 
tribes  of  North  and  South  America,  who  visited  one 
hundred  and  fifty  tribes,  containing  over  two  million 
souls,  tells  us  that  he  was  struck  with  the  low  rate 
of  mortality  among  their  children.  He  states  *  that 
in  one  tribe,  numbering  two  thousand  souls,  he 
learned  from  the  chief  that  the  death  of  a  child 
under  ten  years  of  age  was  a  very  unusual  occur- 
rence ;  and  in  examining  the  cemetery  of  the  tribe, 

*  George  Catlin,  "  Breath  of  Life,"  p.  10. 


INTRODUCTION.  13 

where  the  dead,  enveloped  in  skins,  were  left  rest- 
ing separately  on  little  scaffolds  of  poles,  he  could 
discover,  among  one  hundred  and  fifty  embalm- 
ments, but  eleven  of  children.  Statistics  from  every 
other  tribe  visited  corroborated  the  same  statement. 
In  one  of  the  smaller  tribes,  there  had  occurred 
during  ten  years  only  three  deaths  among  children 
under  ten  years  of  age.  The  query  arises  as  to  the 
cause  of  this  wonderful  difference  in  mortality  be- 
tween civilized  and  primitive  communities.  The 
life  of  the  uncivilized  Indian  child  of  the  past  was 
a  mere  animal  existence:  his  ancestral  stock  was 
sturdy  and  healthy,  he  breathed  a  pure  air,  was  given 
simple  food,  had  abundance  of  sleep,  and  nothing 
to  excite  and  exhaust  the  nervous  system.  In  early 
life  he  was  well  protected  from  cold,  and  was 
taught  regularity  of  habits  and  self-control.  How 
this  contrasts  with  the  personnel  of  most  children  of 
to-day  can  be  best  answered  by  each  mother. 

Naturally  we  would  not  advocate  going  back  to 
the  habits  and  life  of  the  savage  in  order  to  obtain 
vigor  of  childhood,  but  certainly  instructive  lessons 
may  be  learned  by  studying  the  causes  which  led 
to  vigorous  health  among  Indian  children.  Owing 
to  the  requirements  of  civilization,  which  demand 
of  us  more  than  a  mere  animal  existence,  we  can 


14  .    HYGIENE  OF  CHILDHOOD. 

not  expect  the  low  rate  of  mortality  that  existed 
among  the  Indians  in  their  primitive  state.  We 
can  and  should  have,  however,  with  the/  highest 
state  of  civilization,  a  far  lower  death-rate  among 
children  than  generally  exists.  The  requirements 
of  health  are  all  extremely  simple,  and  can  be 
brought  into  application  in  every  household.  The 
drawback  to  the  modern  life — as  far  as  it  affects 
childhood  —  has  been  that  study  and  cultivation 
have  been  extended  to  what  have  been  considered 
weightier  matters  than  the  physical  and  nerve 
health  of  the  young,  which  has  been  more  or  less 
neglected.  Traditional  customs  have  been  the  rule 
for  guidance  rather  than  true  intelligence. 

The  benefits  derived  from  following  certain 
laws  and  regulations  necessary  for  the  maintenance 
of  health  throughout  the  period  of  infancy,  are  ap- 
preciated by  all  observant  mothers.  They  recog- 
nize the  importance  of  the  formation  of  regular 
habits  at  an  early  age,  and  also  the  necessity  of  a 
full  amount  of  sleep  at  regular  hours;  of  a  care- 
fully selected  variety  of  food  given  at  stated  inter- 
vals ;  of  the  protection  of  the  body  from  chill  by 
proper  clothing ;  of  pure  air  to  breathe  indoors ;  of 
cleanliness  and  plenty  of  sunlight  and  outdoor  air. 

After  babyhood,  vigilance  in  following  the  regu- 


INTRODUCTION.  15 

lations  observed  during  infancy  is  so  often  relaxed 
that  I  desire  to  impress  upon  my  readers  the  fact 
that  it  is  of  equal  importance  to  enforce  these  same 
rules  during  the  whole  period  of  childhood,  in  order 
that  the  development  of  the  child  may  not  be  re- 
tarded or  interfered  with. 

Infancy  includes  the  space  of  time  from  birth 
to  the  completion  of  the  first  dentition — about  two 
and  a  half  years — when  childhood  may  be  properly 
said  to  begin.  The  little  one  can  now  make  known 
its  wants  and  discomforts ;  the  dangers  incident  to 
dentition  are  over;  the  nervous  system  is  less  sus- 
ceptible to  all  impressions,  and  not  so  easily  dis- 
turbed by  injudicious  feeding  or  exposure  to  cold, 
dangers  which  are  so  disastrous  at  an  earlier 
age. 

In  proportion  to  the  proper  guidance  and  atten- 
tion given  the  child  during  the  earlier  years  of 
life  will  be  the  strength  of  its  body  at  maturity. 
This  subject,  the  care  of  children,  is  one  that  should 
be  studiously  considered  by  all  parents,  and  should 
receive  more  earnest  thought  than  any  duty ;  for, 
through  want  of  knowledge  on  this  subject,  thou- 
sands of  parents  are  guiding  to  a  physical  perdition, 
and  leading  to  an  early  grave,  their  children,  for 
whose  future  happiness  they  would  willingly  eacri- 


16  HYGIENE  OF  CHILDHOOD. 

fice  their  own  lives.  The  physical  wreck  in  middle 
life,  by  which  the  usefulness  of  the  individual  in 
the  community  is  thwarted,  and  which  blights  his 
hopes  and  ambitions,  after  years  of  preparation,  too 
often  originates  during  the  years  of  development. 
Through  faulty  management  during  the  period  of 
youth,  the  muscles,  bones,  sinews,  nerves,  and  vari- 
ous organs  of  the  body,  have  not  a  hardy  maturity. 
As  a  result,  the  apparent  strength  in  early  man- 
hood is  not  enduring,  the  feebleness  of  tissue  and 
defective  nerve -force  can  not  withstand  the  de- 
mands made  upon  them  in  the  battle  of  life,  and 
the  individual,  like  a  badly  framed  and  timbered 
ship  in  a  storm,  is  unable  to  withstand  the  strain, 
and  is  wrecked. 

Moral,  mental,  and  physical  training  of  children 
are  equally  important,  but  I  shall  chiefly  confine 
my  remarks  to  the  physical,  which,  if  properly 
conducted,  insures  a  more  complete  enjoyment  of  a 
good  moral  and  mental  training.  I  wish,  however, 
to  suggest  one  thought  for  consideration,  namely, 
that  the  moral  welfare  of  a  being  is  very  often  de- 
pendent upon,  or  influenced  by,  the  physical  and 
mental  condition.  With  a  healthy  body  and 
healthy  nerve-force  there  is  far  less  likelihood  of  a 
low  state  of  morals  than  when  the  physical  system 


INTRODUCTION.  17 

is  imperfect,  when  the  digestive  organs  have  been 
perverted  by  improper  and  too  stimulating  food, 
and  the  nerve -force  exhausted  by  too  profound 
mental  work,  and  an  insufficient  amount  of  sleep 
during  the  period  of  youth. 

In  the  works  of  Nature,  unvarying  regularity 
must  be  observed  in  order  that  perfection  may  be  at- 
tained, and  the  workings  of  the  human  organism  are 
no  exception  to  this  established  rule.  The  organs 
of  digestion  acquire  the  habit  and  power  of  digest- 
ing food  at  regular  intervals,  the  bowels  of  dis- 
charging the  waste  material,  and  the  brain  of  seek- 
ing repose ;  and  various  disturbances  in  their  func- 
tions and  in  the  system  result  if  there  is  any  inter- 
ruption in  their  habits. 

During  these  important  years,  therefore,  when 
the  child  is  rapidly  developing,  no  pains  should  be 
spared  to  establish  habits  of  regularity.  They  are 
essential  to  a  healthy  existence.  When  once  fairly 
established,  Nature's  love  for  order  will  create  a  de- 
sire in  the  child  to  continue  these  habits.  That 
which  at  first  may  have  been  difficult  to  implant, 
takes  deep  and  permanent  root. 


18  HYGIENE  OF  CHILDHOOD. 

DIETAKY  DURING  CHILDHOOD. 

All  the  tissues  and  organs  of  the  body  require 
for  their  healthy  development  blood  of  a  good,  nour- 
ishing quality  and  of  sufficient  amount,  to  obtain 
which  it  is  essential  that  the  material  from  which 
the  blood  is  made,  food,  should  be  suitable  both  in 
quality  and  quantity,  and  that  the  digestive  organs 
which  transform  the  food  into  blood  should  per- 
form their  functions  in  a  perfectly  healthy  manner. 

It  is  a  truism  that,  during  childhood,  simplicity 
of  food  is  essential  to  perfect  digestion.  In  order 
that  the  functions  of  digestion  may  be  properly 
carried  on,  such  food  only  should  be  given  as  can 
be  digested  with  ease,  and  then  these  functions 
should  be  allowed  an  interval  of  rest  before  the 
next  meal.  By  rest,  is  meant  a  period  of  time 
when  the  glands — whose  duty  it  is  to  manufacture 
the  digestive  fluids — are  not  in  active  operation. 

This  glandular  activity  ceases  only  when  there 
is  no  food  in  the  stomach  and  intestines,  or  when 
the  food  is  in  a  condition  for  absorption.  If  the 
necessary  amount  of  rest  is  not  obtained,  then  these 
glands  are  kept  too  long  in  a  state  of  congestion,* 

*  By  congestion  is  meant  that  a  greater  amount  of  blood  is  sup- 
plied to  the  part  in  question  than  is  the  case  when  the  part  is  in  a 


DIETARY  DURING   CHILDHOOD.  19 

and  soon  cease  to  do  their  work  properly,  and  there 
results  what  is  commonly  called  an  attack  of  indi- 
gestion, the  stomach  and  bowels  becoming  irritable, 
and  loss  of  appetite  and  strength,  fever,  pain,  vom- 
iting, diarrhoea,  etc.,  ensuing.  It  is  just  as  absurd 
to  expect  that  the  stomach  of  a  young  child  should 
be  capable  of  digesting  the  hearty  food  suitable  for 
an  adult  as  to  expect  that  its  arms  should  lift  as 
heavy  a  weight,  or  its  legs  should  carry  it  as  fast 
or  as  far. 

Food  is  taken  into  the  body  for  the  purposes  of 
growth,  for  the  formation  of  animal  heat,  and  for  *-. 
the  restoration  of  tissues  that  are  destroyed  or  used 
up  in  the  maintenance  of  the  various  functions  of 
the  animal  organism.  It  may  be  subdivided  into 
three  great  classes — the  carbonaceous,  the  nitroge- 
nous, and  the  mineral  salts  and  water. 

The  oily,  fatty,  and  saccharine  elements  in  food 

state  of  repose  or  inactivity.  When  any  one  function  of  the  body  is 
called  into  activity,  as  the  brain  in  thinking,  the  stomach  or  intesti- 
nal canal  in  digesting,  the  liver  or  any  of  the  various  glands  or  or- 
gans of  the  body  in  the  performance  of  their  duty,  there  instantly 
takes  place  an  accession  of  blood  at  the  point  of  increased  activity, 
and  a  healthy  state  of  congestion  takes  place.  If,  however,  this 
congestion  is  too  long  maintained  from  the  excessive  amount  of 
work  required,  the  healthy  action  of  the  gland  or  organ  is  interfered 
with,  and  a  diseased  state  is  the  result.  Congestion  is  also  brought 
about  through  the  agency  of  cold,  as  we  shall  see  later  on. 


20  HYGIENE  OF  CHILDHOOD. 

— classed  as  carbonaceous — are  chiefly  appropriated 
for  the  formation  of  heat  and  the  nutrition  of  the 
nervous  system,  and  that  which  is  not  immediately 
utilized  is  deposited  as  fatty  or  adipose  tissue  be- 
neath the  skin.  This  adipose  tissue  fulfils  a  three- 
fold mission — it  rounds  out  and  beautifies  the  body ; 
it  protects  the  inner  organs  and  deeper  structures 
from  injury;  and  is  a  reservoir  for  providing  the 
heat-making  powers  with  fuel  and  the  nervous  sys- 
tem with  food  whenever  an  extra  amount  is  called 
for.  The  nitrogenous  element  in  food  is  principally 
used  in  the  formation  of  the  muscular  structure  and 
the  fibrous  framework,  and  derives  its  chief  supply 
from  animal  meat ;  eggs,  and  some  of  the  cereals 
and  vegetables,  however,  furnish  a  large  amount  of 
this  element. 

Purely  carbonaceous  food  can  not  supply  mate- 
rial for  building  up  strong  muscular  or  fibrous 
structure,  nor  can  purely  nitrogenous  food  keep  up 
the  necessary  degree  of  animal  heat  and  vigorous 
nerve-force.  A  mixed  diet,  therefore,  is  essential 
to  the  proper  development  of  the  body.  It  is, 
moreover,  important  to  give  due  thought  to  the 
character  of  food,  in  order  that  every  tissue  may 
have  abundance  of  its  own  necessary  nutriment. 
That  is,  the  bony  structure  should  be  able  to  select, 


DIETARY  DURING  CHILDHOOD.  21 

from  the  food  taken  in,  sufficient  phosphate  of  lirne 
and  other  mineral  salts  for  the  building  up  of  a 
firm,  solid  framework.  The  muscles  should  have 
an  ample  amount  of  nitrogenous  food  in  order  that 
they  may  grow  stronger.  So,  too,  the  nervous  sys- 
tem demands  a  large  supply  of  food  containing  fat 
and  the  phosphates  in  order  that  it  may  possess  a 
healthy  nerve-force  and  the  ability  to  maintain  the 
necessary  degree  of  animal  heat. 

During  the  early  months  of  life,  milk  furnishes 
all  that  is  requisite  for  the  development  of  every 
part  of  the  little  being.  But  with  growth  there  is 
an  increased  demand  upon  the  muscles  and  other 
tissues  for  work,  so  that  additional  and  heartier 
food  is  required  to  maintain  a  sufficient  supply  of 
nutriment.  Milk,  however,  containing  as  it  does 
elements  that  nourish  brain,  muscle,  and  nerve,  and 
give  fuel  for  animal  heat,  should  constitute  one  of 
the  staple  articles  of  diet  for  all  children  through- 
out the  whole  period  of  adolescence,  and  its  use 
should  always  be  encouraged.  It  is  unequalled  as 
an  article  of  food  for  the  young,  since  all  its  com- 
ponent parts  are  quickly  assimilated  and  appropri- 
ated in  the  system  without  any  undue  tax  upon  the 
digestive  organs.  The  fat  of  milk  being  in  a  state 
of  fine  subdivision  and  readily  taken  up  by  the  ab- 


22  HYGIENE  OF  CHILDHOOD. 

sorbents  of  the  digestive  tract,  is  especially  benefi- 
cial and  more  acceptable  than  the  fatty  elements 
contained  in  other  varieties  of  food. 

Children  after  leaving  babyhood  not  unfrequent- 
ly  rebel  against  milk,  manifesting  a  disgust  for  it. 
Parents  should  be  careful  not  to  yield  to  these 
whims,  as  in  the  vast  majority  of  cases  it  is  nothing 
but  fancy,  for  this  food  is  too  valuable  an  article  of 
diet  to  be  hastily  put  aside.  If  the  milk  is  very  rich 
with  cream,  it  may  occasionally  give  rise  to  disor- 
dered digestion,  especially  with  children  of  a  so- 
called  bilious  temperament.  The  milk  from  the 
Alderney  cow  may  not  agree  with  some  children  on 
account  of  its  richness  in  cream,  while  that  from 
the  common  cow  will  be  perfectly  acceptable.  In 
fact,  with  the  majority  of  children,  young  and  old, 
the  milk  from  the  common  cow  is  preferable  to 
that  from  the  Alderney.  When  there  is  an  actual 
distaste  for  milk,  the  addition  of  a  little  salt  will 
give  it  more  relish,  just  as  salt  improves  the  flavor 
of  meat. 

Certain  of  the  cereals  rank  next  to  milk  as 
articles  of  nutriment.  Oatmeal,  wheaten  grits, 
hominy,  imperial  granum,  rice,  and  farina  are  the 
most  valuable,  and  should  form  part  of  the  child's 
diet.  Of  these  oatmeal  is  the  richest  in  nutriment. 


DIETARY  DURING   CHILDHOOD.  23 

Analysis  shows  that  it  contains  a  higher  percentage 
of  fat  and  mineral  salts  (phosphate  of  lime  chiefly) 
than  any  of  the  other  cereals,  and  with  the  excep- 
tion of  corn  it  contains  more  sugar.  It  is  also  rich 
in  nitrogenous  or  albuminous  principles,  but  has  a 
smaller  percentage  of  starch  than  the  other  grains. 
There  is  one  other  element  in  oatmeal  which  may 
become  as  much  a  source  of  danger  as  it  is  of  bene- 
fit. I  allude  to  the  cellulose  or  cell  structure.  It 
contains  more  of  this  waste  material  than  any  other 
cereal.  The  danger  lies  in  the  fact  that  the  digest- 
ive fluids  can  not  obtain  ready  access  to  the  nutri- 
ment incased  in  this  cellular  structure  when  insuffi- 
ciently cooked,  as  is  too  often  the  case,  and  the 
grain  is  thus  rendered  an  indigestible  article  of  food 
for  a  delicate  stomach.  Oatmeal  should  be  given  at 
least  two  and  a  half  or  three  hours  cooking,  in  order 
to  disintegrate  or  break  up  the  hard,  cellular  en- 
velope surrounding  the  true  nutriment.  When  thor- 
oughly cooked  it  will  lose  its  granular  form  and  as- 
sume a  gelatinous  appearance.  The  cellular  or  waste 
material  is  beneficial  because  its  presence  in  the 
bowels  stimulates  the  peristaltic  action  and  promotes 
daily  evacuation.  In  proportion  to  size  the  child 
requires  a  greater  amount  of  food  for  nerve  nutri- 
tion and  for  developing  heat  than  the  fully  devel- 


24  HYGIENE  OF  CHILDHOOD. 

oped  man  ;  this  is  necessary  in  order  to  supply  the 
wants  required  in  growth  and  the  force  expended 
in  restless  activity, 

In  addition  to  fat,  there  is  another  article  which 
is  heat-making,  namely,  sugar,  and  also  to  a  slight 
degree  the  starch  of  farinaceous  food,  for  the  starch 
is  converted  into  sugar  in  the  system.  '  The  natural 
longing  for  sweets  is  often  more  than  a  desire  to 
gratify  the  palate.  It  is  a  craving  upon  the  part  of 
nature  for  carbohydrates.  \  It  is,  therefore,  perfectly 
natural,  under  certain  restrictions,  to  give  sugar  or 
molasses  with  food.  The  great  danger,  in  giving 
saccharine  articles  of  food,  consists  not  so  much  in 
their  use  as  in  their  abuse.  A  certain  amount  of 
sugar  or  candy  is  harmless  for  children,  but  it  should 
be  given  with  food,  or  immediately  after  eating,  and 
in  small  quantities.  "When  sweets  or  candies  are 
given  between  meals,  an  acid  fermentation  is  apt 
to  take  place,  the  digestion  becomes  deranged,  the 
appetite  fails,  and  does  not  return  until  the  sweets 
are  abandoned.  Children  whose  diet  is  largely  com- 
posed of  farinaceous  food  and  milk,  with  a  proper 
amount  of  butter,  do  not  as  a  rule  crave  sweets  as 
strongly  as  when  these  articles  are  sparingly  given. 
The  rule  I  would  suggest  is  that,  when  a  child  is 
vigorous,  with  digestion  in  good  order,  and  takes 


DIETARY  DURING   CHILDHOOD.  25 

plenty  of  milk  and  farinaceous  food,  you  may  give 
sweets  and  candies  in  moderation ;  but  when  the 
digestion  is  defective,  appetite  poor,  tongue  coated 
or  the  child  is  delicate,  sweets  should  be  withheld. 

Eggs  constitute  a  concentrated  and  digestible 
nutriment.  The  white  is  composed  chiefly  of  albu- 
men, a  nitrogenous  element,  and  the  yolk  largely 
of  fat. 

Meat  is  essentially  a  nitrogenous  article  of  diet ; 
it  builds  up  the  muscles,  but,  as  muscle-making  or 
nitrogenous  elements  are  also  found  in  farinaceous 
food,  white  of  eggs,  and  milk,  a  large  amount 
of  meat  is  not  necessary.  On  the  contrary,  it  is 
actually  injurious,  as,  if  it  forms  the  greater  part  of 
the  meal,  it  thereby  deprives  the  system  of  the  fat 
and  nerve  making  food,  which  is  so  essential  for 
animal  heat  and  nerve-force,  and  it,  moreover,  acts 
as  an  irritant  upon  the  bowels  and  kidneys.  Young 
children  who  are  large  meat-eaters  are  very  slender, 
prone  to  have  coated  tongues,  foul  breath,  and  indi- 
gestion. They  are  also  given  to  talking  in  their 
sleep;  whereas,  when  the  diet  consists  largely  of 
milk,  farinaceous  food,  light  vegetables,  and  only  a 
judicious  amount  of  meat,  children  are  fatter,  have 
a  healthier  complexion,  rosier  cheeks,  and  are  gener- 
ally of  a  happier,  brighter  disposition.  It  is  well  to 


26  HYGIENE  OF  CHILDHOOD. 

teach  children,  when  they  are  old  enough  to  take 
hearty  food,  that  they  should  eat  the  fat  of  meat. 
Fat  is  important  for  developing  nerve-force.  It  is 
also  essential,  as  we  have  already  stated,  for  keep- 
ing up  animal  heat,  and  furnishes  the  basis  of  all 
cell  nutrition.  By  fat  we  do  not  mean  grease. 
The  natural  fat  that  is  taken  with  meat,  milk,  and 
butter  is  wholesome  and  desirable,  and  is  very  easily 
assimilated ;  but  made  meat-gravies  and  all  kinds  of 
food  fried  in  grease  are  indigestible,  and  should 
never  be  given  to  a  child. 

An  instinct  evinced  by  most  children  is  the 
desire  for  vegetable  acids — in  the  form  of  fruit. 
This  desire  should  be  indulged.  Where  note  is 
taker  of  what  nature  thus  craves,  by  supplying  a 
sufficient  quantity  of  good  ripe  fruit,  the  child  will 
not  resort  to  the  sour,  unripe  apples,  gooseberries, 
and  other  fruit  which  are  such  prolific  causes  of 
bowel  trouble  in  summer.  Ripe  fruit  is  not  only 
acceptable  to  children,  but  it  is  an  important  article 
of  diet  for  them.  "When  fruit  is  taken  in  modera- 
tion, the  vegetable  acid  contained  therein  exerts  a 
beneficial  effect  upon  the  digestive  organs,  being  in 
itselr  a  good  tonic. 

During  the  early  years  of  childhood — that  is, 
from  two  to  six  years  of  age — milk  should  consti- 


DIETARY  DURING   CHILDHOOD.  27 

tute  the  greater  portion  of  the  food ;  of  course,  fari- 
naceous food,  easily  digestible  vegetables,  good  ripe 
fruit,  eggs,  and  meat  should  be  given.  The  impor- 
tance of  the  last  article,  meat,  is  however  apt  to 
be  overestimated  during  early  life.  A  little  fresh 
meat  once  a  day  should  be  given,  but,  except  from 
ill  health,  and  by  the  advice  of  a  physician,  a  child 
under  seven  should  never  have  meat  more  than 
once  a  day. 

As  the  child  approaches  the  age  of  eight  or 
nine  years — when  it  is  full  of  life  and  vigor — 
meat  is  generally  required  more  than  once  a  day 
— that  is,  meat  with  the  dinner,  and  a  little  in 
the  morning  for  breakfast.  Be  careful,  however, 
not  to  let  meat  diet  crowd  out  other  varieties  of 
food.  A  vigorous  child  of  twelve  or  fourteen  years 
of  age  requires  as  much  nutriment  as  a  grown  man. 
The  taste  for  fresh  vegetables  should  be  cultivated ; 
roasted  and  mashed  potatoes,  fresh  peas,  string 
beans,  asparagus,  boiled  onions,  lettuce,  and  spinach, 
are  especially  digestible  and  desirable  for  children 
over  three  years  of  age.  The  vegetable  acids  assist 
digestion,  and  the  cellular  matter  contained  in  the 
vegetable,  by  stimulating  the  bowels  to  healthy  ac- 
tion, is  instrumental  in  eliminating  from  the  system 
waste  material.  Celery  and  tomatoes  raw,  also 


28  HYGIENE  OF  CHILDHOOD. 

the  following  cooked  vegetables — beets,  cauliflower, 
turnips,  corn,  parsnips,  carrots,  cabbage,  egg-plant — 
should  be  given  only  to  older  children.  Ham, 
pork,  liver,  tongue,  corned  beef,  and  all  salted 
fish  are  difficult  of  digestion  and  should  be  forbid- 
den food  for  young  and  delicate  children.  Fresh 
meat  should  be  either  roasted,  boiled,  broiled,  or 
stewed,  but  should  never  be  fried.  Fresh  fish  and 
oysters  are  wholesome,  and  help  to  vary  the  bill  of 
fare  for  older  children.  Pastry,  fresh  home-made 
bread,  and  hot  biscuits  are  articles  of  food  very  dif- 
ficult of  digestion,  and  should  never  be  given  to 
young  children.  If  a  child  of  twelve  or  fourteen 
years  of  age  is  robust,  has  good  digestion,  and  eats 
heartily  of  proper  food,  pastry  can  now  and  then 
be  given,  but  should  be  absolutely  avoided  under 
any  other  circumstances.  To  a  child  under  thir- 
teen years  of  age  tea  and  coffee  should  never  be 
permitted ;  indeed,  it  would  be  better  to  postpone 
their  use  as  long  as  possible.  They  are  unneces- 
sary; besides,  they  are  excitants,  and  are  prone 
to  derange  the  digestion.  To  maintain  a  healthy 
digestion  all  stimulating  food  should  be  rigidly 
avoided.  Pickles,  pepper,  spices,  and  highly  sea- 
soned food  should  be  forbidden,  not  only  for  the 
same  reason  that  we  forbid  tea  and  coffee,  but 


DIETARY  DURING   CHILDHOOD.  £9 

because  they  pervert  the  appetite,  create  in  the 
child  a  desire  for  highly  seasoned  food,  which  de- 
sire, when  fostered,  leads  in  turn  directly  to  intem- 
perance in  later  life.  If,  during  childhood  and  early 
youth,  the  stomach  were  kept  free  from  the  bane- 
ful influence  of  all  stimulating  food,  I  am  convinced 
that  there  would  be  fewer  drunkards. 

A  child  of  from  three  to  five  years  of  age  is  too 
frequently  put  to  bed  immediately  after  eating  a 
supper  consisting  of  milk,  bread  and  butter,  and  a 
liberal  allowance  of  jam.  The  mother  or  nurse 
comments  the  following  morning  on  the  restless  or 
dreaming  and  startled  sleep  of  the  child,  and  rarely 
connects  the  supper  allowance  of  jam  with  the  re- 
sultant night-dreams.  The  supper  of  a  child  of  this 
age  should  be  very  simple — bread  and  milk,  or 
cereals  and  milk,  with  bread  and  butter  is  all  that  is 
necessary.  The  jam  causes  indigestion,  distends  the 
bowels  with  wind,  and  disturbs  the  whole  circula- 
tion, especially  of  the  brain. 

Little  or  no  harm  will  be  experienced  by  per- 
mitting a  child  to  completely  satisfy  the  appetite, 
provided  the  food  is  thoroughly  masticated  and 
eaten  slowly.  It  is  only  when  indigestible  food  is 
taken,  or  when  the  food  is  "  bolted,"  that  there  is  dan- 
ger of  overfeeding  and  of  harm  ensuing. 


30  HYGIENE  OF  CHILDHOOD. 

Children  during  school-life  must  be  abundantly 
fed,  for  not  only  is  the  growth  rapid  but  there  is 
a  great  wear  and  tear  of  body  and  mind  while  at 
work  and  at  play.  If  they  are  not  properly  nour- 
ished at  this  critical  time,  they  develop  badly,  their 
blood  becomes  poor,  and  hereditary  tendencies  are 
encouraged.  Yariety  and  palatability  of  food  must 
be  studied  as  well  as  regularity  of  meals.  At  this 
period — that  is,  after  six  or  seven  years  of  age — it  is 
always  important  to  see  that  the  interval  between 
meals  is  not  too  long,  for  by  prolonged  fasting  many 
children  are  very  much  injured.  A  glass  of  milk,  or 
a  little  bread  and  butter  between  breakfast  and  din- 
ner, or  between  dinner  and  supper,  is  a  great  help 
in  sustaining  strength  and  vigor,  and  very  impor- 
tant to  a  child  who  is  delicate,  or  whose  appetite 
is  small.  It  is  permissible,  also,  to  give  between 
meals,  to  a  child  who  is  taking  a  great  deal  of  ex- 
ercise, light,  digestible  food  of  the  kind  mentioned, 
provided  it  is  given  with  a  degree  of  regularity, 
and  not  near  the  hours  for  the  regular  meals.  If, 
on  the  other  hand,  the  child  is  allowed  to  eat  at 
irregular  intervals,  whatever  and  whenever  the  ap- 
petite dictates,  the  functions  of  digestion  are  often 
so  perverted  that,  for  the  remaining  years  of  life, 
he  is  likely  to  become  a  confirmed  dyspeptic ;  and 


DIETARY  DURING   CHILDHOOD.  31 

dyspepsia,  as  we  know,  is  but  the  starting-point  of 
many  diseases.  Sir  Henry  Thompson,  in  his  little 
monogram  on  "  Diet  in  Kelation  to  Age  and  Activ- 
ity," says  .  .  .  "  I  have  for  some  years  past  been 
compelled,  by  facts  which  are  constantly  coming  be- 
fore me,  to  accept  the  conclusion  that  more  mischief 
in  the  form  of  actual  disease,  of  impaired  vigor, 
and  of  shortened  life,  accrues  to  civilized  man,  so 
far  as  I  have  observed  in  our  own  country  and 
throughout  Western  and  Central  Europe,  from 
erroneous  habits  in  eating,  than  from  the  habitual 
use  of  alcoholic  drinks,  considerable  as  I  know  the 
evil  of  that  to  be."  * 

If  erroneous  habits  of  eating  have  such  a  bane- 
ful effect  upon  adults,  the  effect  upon  those  of  ten- 
derer years  must  be  manifestly  greater ;  and  it  cer,- 
tainly  behooves  parents  carefully  to  scrutinize  the 
quality  of  food  provided  for  their  children,  as  well 
as  the  manner  and  time  of  taking  it. 

Whenever  the  digestion  is  deranged,  there  is 
not  only  a  deprivation  of  a  certain  amount  of  nutri- 
ment, but  the  incomplete  products  -of  digestion, 
which  are  taken  into  the  circulation,  exert  a  delete- 
rious effect  upon  the  nervous  system,  and  create 

*  Sir  H.  Thompson,  "  Diet  in  Kelation  to  Age  and  Activity,"  p.  4. 


32  HYGIENE  OF  CHILDHOOD. 

more  or  less  irritability  of  temper,  or  a  condition  of 
moroseness.  When  this  state  is  of  short  duration, 
no  serious  results  follow;  but  when  frequently  re- 
peated, or  if  long  continued,  a  lasting  impression 
upon  the  temperament  and  physique  is  the  result. 
Then,  again,  if  the  digestive  tract  is  frequently  dis- 
turbed, and  especially  if  the  liver  is  kept  in  defect- 
ive action,  owing  to  irregular  or  improper  kinds  of 
nutriment  taken  during  the  period  of  youth,  that 
time  when  the  healthy  growth  and  development  of 
these  parts  should  take  place,  an  imperfect  or  mor- 
bid development  is  apt  to  ensue,  which  must  result 
in  impaired  health  and  disease  in  later  life. 

During  the  period  of  school-life,  meals  are  apt 
to  be  taken  with  great  irregularity.  Hurrying  to 
school,  and  again  hastening  to  afternoon  play,  cause 
the  child  to  forget  hunger  in  the  eager  desire  to 
join  his  comrades ;  then  coming  home  with  hearty 
appetite  sharpened  by  exercise,  he  will  eat  often 
whatever  he  can  find,  however  indigestible,  and  the 
true  appetite  for  the  following  healthy  meal  is 
gone.  The  child  should  not  only  have  his  meals 
regularly,  but  he  should  be  compelled  to  spend 
sufficient  time  at  them — to  eat  slowly  and  without 
excitement.  Food  should  be  carefully  cut  in  small 
pieces  before  putting  it  into  the  mouth,  and  masti- 


DIETARY  DURING   CHILDHOOD.  33 

cated  thoroughly,  in  order  that,  when  it  reaches  the 
stomach,  the  digestive  juices  can  act  upon  it  and 
more  readily  reduce  it  to  a  solution  for  absorption. 
Hurry  and  excitement  when  eating  divert  the  at- 
tention of  the  nerve-force  from  the  act  of  diges- 
tion, and  consequently  food  is  not  so  well  digested. 
Repose  and  quietness,  on  the  other  hand,  favor  the 
digestive  act.  It  is  therefore  important  that  a 
child  should  ba  compelled  to  eat  slowly,  and  never 
be  permitted  to  leave  the  table  until  all  shall  have 
finished ;  otherwise  the  food  is  likely  to  be  insuffi- 
ciently masticated,  and  the  habit  of  u  bolting  "  his 
food  will  soon  be  acquired. 

It  will  be  often  observed  that  children  of  deli- 
cate physique,  possessing  an  active  and  nervous 
temperament,  play  with  so  much  earnestness  that, 
although  eating  generously  for  breakfast,  they  have 
a  poor  appetite  for  dinner  and  supper,  and  in  con- 
sequence do  not  obtain  the  necessary  amount  of 
nutriment.  This  too  active  exercise  just  before 
meal-time  creates  a  physical  exhaustion  which  the 
child  in  his  excitement  does  not  recognize,  but 
which  has  affected  his  digestive  organs.  This  fail- 
ure of  appetite  may  be  averted  by  enforcing  com- 
plete rest  for  half  an  hour  or  more  preceding  each 

meal. 

s 


34  HYGIENE  OF  CHILDHOOD. 

A  child's  digestion  may  be  seriously  impaired 
by  unsuitable  lunch  prepared  for  him  to  take  to 
school.  Such  injurious  tilings  as  pies,  cakes,  and 
sweets,  are  slipped  into  the  basket,  to  "  tempt  his 
appetite,"  or  he  is  given  a  few  pennies  with  which 
to  purchase  tarts  and  cakes  from  the  nearest  con- 
fectioner. I  need  not  say  that  this  habit  is  pro- 
ductive of  immense  mischief;  indigestion,  a  sour 
stomach,  and  loss  of  appetite  for  the  regular  meal 
awaiting  his  return  from  school,  are  but  a  small  part 
of  the  damage.  The  lunch  should  be  simple,  appe- 
tizing, and  put  up  in  an  attractive  form,  in  clean 
fresh  doylies  rather  than  paper  as  a  wrapper  inside 
the  basket,  and  it  should  consist  of  nicely  prepared 
bread  and  butter,  or  sandwiches  made  with  mutton, 
beef,  or  chicken,  finely  chopped  or  in  slices,  one 
or  two  hard-boiled  eggs  for  older  children,  or  the 
yolk  of  a  hard-boiled  egg.  A  little  stale  sponge- 
cake, or  a  few  ginger-snaps,  or  well-cooked  ginger- 
bread and  fruit,  may  be  allowed,  provided  there  is 
a  certainty  that  the  more  substantial  nourishment 
is  also  eaten.  Sandwiches  made  with  ham  or  cold 
corned  beef  should  not  be  given.  A  child  under 
ten  years  of  age  should  never  be  kept  at  school 
long  enough  to  necessitate  carrying  a  luncheon.  If 
the  school  opens  at  nine  o'clock,  the  child  should 


DIETARY  DURING   CHILDHOOD.  35 

return  by  half-past  twelve,  and  the  school  hours  for 
the  day  be  finished.  In  the  case  of  older  children, 
the  custom  existing  in  many  country  towns  of  a 
long  intermission  from  twelve  until  two  o'clock  is 
certainly  beneficial  to  health.  It  allows  sufficient 
time  to  walk  home  leisurely,  and  to  eat  quietly, 
so  that  the  digestive  process  is  fairly  under  way 
before  returning  to  the  afternoon  duties. 

Errors  in  diet  bring  about  disastrous  effects  aside 
from  depriving  the  child  of  robust  health  through 
lack  of  the  proper  kind  of  nutriment.  There  is  a 
close  relationship  between  the  digestive  organs,  the 
mouth,  the  upper  part  of  the  throat,  and,  to  a  cer- 
tain extent,  the  nose.  This  connection  is  in  a  meas- 
ure evident  to  every  one  who  has  given  any  thought 
to  the  symptoms  of  disease,  as  shown  in  the  coated 
tongue ;  and  most  observant  mothers  recognize  that 
croup  and  canker-sore  mouths  are  manifestations  of 
stomach  trouble,  few  realizing,  however,  that  swollen 
tonsils,  sore  throat,  thickened  and  roughened  catar- 
rhal  state  of  the  back  part  of  the  throat  and  nose, 
may  originate  from  the  same  cause  which  gave  rise 
to  the  coated  tongue.  False  croup,  which  strikes 
terror  to  the  heart  of  the  mother  by  its  sudden 
advent  at  night,  is  almost  invariably  due  to  some 
error  in  diet  on  the  day  previous,  or  is  the  result 


36  HYGIENE  OF  CHILDHOOD. 

of  cold  disturbing  the  digestion  and  arresting  the 
action  of  the  liver.  Canker  in  the  mouth,  or  an 
liberation  of  the  mucous  membrane  of  the  mouth, 
is  the  direct  result  of  an  acrid  condition  of  the 
stomach.  So,  too,  a  general  catarrhal  state  of  the 
upper  air-passages  (nose,  pharynx,  and  larynx)  is 
frequently  resultant  from  oft-repeated  errors  in 
diet,  as  when  pastry,  too  much  sweets,  condiments, 
and  other  improper  articles  of  food  are  given ;  and 
when  this  catarrhal  condition  is  brought  about  from 
other  causes,  it  is  fostered  and  aggravated  by  mal- 
digestion. 

Unwholesome  food,  therefore,  exerts  a  twofold 
injury  on  a  child  :  through  its  irritating  effect,  there 
is  a  loss  of  appetite,  lack  of  perfect  assimilation  of 
food,  and  consequently  a  deprivation  of  proper  ele- 
ments for  building  up  healthy  tissue  ;  and  also  the 
induced  indigestion  frequently  creates  a  catarrhal 
state  of  the  upper  part  of  the  throat  and  nose,  a 
condition,  which,  as  I  shall  explain  later  on,  is  of 
great  detriment  to  perfect  health. 

The  question  should  children  be  permitted  to 
follow  out  their  own  fancies  regarding  the  food  they 
are  to  eat,  is  a  subject  often  discussed  by  parents. 
Because  there  is  a  dislike  to  oatmeal,  or  hominy,  or 
meat,  or  milk,  or  any  other  article  of  food  suitable 


DIETARY  DURING   CHILDHOOD.  37 

for  a  child,  shall  this  dislike  indicate  the  bill  of  fare, 
and  the  distasteful  article  be  omitted  ?  I  must  from 
my  own  observation  give  a  negative  answer.  A 
young  child  is  a  perfectly  helpless  being,  dependent 
for  all  things  upon  the  guidance  of  its  elders ;  with- 
out instruction  it  is  incapable  of  selecting  proper 
food.  I  might  almost  say  that  the  appetite  is  by 
nature  perverse,  and  requires  as  much  guidance  as 
the  morals  and  education.  The  youngest  child  will 
often  take  with  apparent  relish  tea,  coffee,  wines, 
brandy,  spices,  and  food  which  a  judicious  person 
knows  must  be  harmful  to  its  delicate  stomach.  In 
the  majority  of  cases  a  child's  taste  may  be  culti- 
vated for  any  article  of  food.  Unsavory  food,  in- 
sufficient cooking  of  farinaceous  food,  and  sameness 
of  bill  of  fare,  aside  from  notions  and  whims,  are 
great  causes  for  creating  dislike  to  certain  articles 
of  diet.  The  same  food  should  not  be  given  with 
such  frequency  that  children  begin  to  dislike  it.  It 
must  be  remembered  that  a  variety  is  essential  to 
good  appetite  and  digestion. 

One  mother  will  say  that  her  children  will  not 
eat  farinaceous  food,  another  that  they  will  not 
drink  milk,  another  that  they  will  not  take  vegeta- 
bles. AVhen  this  is  the  case,  the  inference  is  that 
the  mother  has  not  exerted  proper  control,  or  com- 


38  HYGIENE  OF  CHILDHOOD. 

menced  the  guidance  of  her  children  early  enough. 
With  a  few  exceptions  every  child  can  be  taught  to 
take  farinaceous  food,  milk,  vegetables,  and  all 
articles  suitable  for  a  child  to  eat.  In  cultivating  a 
liking  for  a  distasteful  food,  place  only  one  or  two 
tea-spoonfuls  of  the  food  on  the  child's  plate,  and 
insist  upon  it  being  eaten  or  taken  as  a  dose  of 
medicine ;  if  this  is  repeated  from  time  to  time,  but 
not  too  frequently,  the  taste  for  the  food  will  in  the 
majority  of  instances  be  acquired.  If,  however,  a 
large  quantity  of  the  distasteful  article  is  placed 
before  the  child,  the  horror  and  disgust  for  it  will 
be  intensified.  I  have  known  a  great  many  in- 
stances where,  by  following  this  suggestion,  children 
have  acquired  a  fondness  for  the  food  which  they 
formerly  abhorred. 

Enforcing  a  bill  of  fare  that  is  distasteful  re- 
quires, however,  good  judgment,  because  children  as 
well  as  adults  have  idiosyncrasies,  and  may  be  un- 
able to  digest  certain  food  even  though  it  be  good. 
If,  therefore,  after  a  fair  trial,  it  is  fully  ascertained 
that  a  child  thoroughly  abhors  certain  articles  of 
diet,  and  can  not  digest  them,  it  is  only  right  that 
the  objectionable  articles  should  be  discarded.  It 
often  happens  that  children  who  are  whimsical  and 
notional  about  food,  who  rule  their  parents,  and  are 


PROTECTION  OF  THE  BODY.  39 

their  own  guides  as  to  what  they  will  or  will  not 
eat,  are  apparently  none  the  worse  for  the  improper 
food ;  it  is  when  illness  overtakes  them  that  the 
results  of  this  misguidance  are  apparent.  I  recall 
many  instances  where  children,  who,  when  in  health, 
had  been  allowed  to  gratify  their  appetites,  and  had 
never  been  taught  to  exercise  self-control  and*  to 
observe  obedience  in  eating,  have  refused,  when 
they  became  seriously  ill,  every  article  of  diet  usu- 
ally administered  to  the  sick*.  Nourishment  was 
given  only  under  an  excitement  and  struggle, 
although  pie,  cake,  hot  bread,  and  other  accus- 
tomed articles  of  food  were  called  for.  How 
different  the  case  when  a  child  obeys  and  takes 
all  food  given !  I  have  known,  repeatedly,  cases 
where  the  lives  of  children,  precious  to  their  par- 
ents, could  have  been  saved  if  the  parents  had 
exercised  a  little  more  judgment,  and  had  not  only 
taught  their  children  to  eat  proper  kinds  of  food, 
but  had  enforced  obedience  in  eating  whatever  was 
placed  before  them. 

PROTECTION  OF  THE  BODY. 

The  physiological  action  of  cold  and  its  danger- 
ous effect  upon  the  human  frame  seem  to  be  imper- 
fectly understood  by  most  parents.  They  associate 


40  HYGIENE  OF  CHILDHOOD. 

the  immediate  result  of  a  cold,  in  creating  a  cough, 
or  some  disorder  of  the  breathing  apparatus,  as 
about  the  only  evil  resulting  from  undue  exposure, 
or  from  chilling  the  surface  of  the  body  through  too 
scanty  clothing,  and  appear  to  be  unaware  of  the 
disastrous  disturbance  a  cold  produces  in  other  or- 
gans of  the  body.  It  is  a  peculiarity  of  the  human 
frame  that  a  definite  standard  of  heat  must  be  main- 
tained in  order  to  have  perfect  health.  This  stand- 
ard is  always  the  same,  whether  one  is  living  in  the 
arctic  region  or  at  the  equator,  the  body  having 
means  within  itself  of  preserving  this  fixed  degree ' 
of  temperature.  The  forces  that  originate  animal 
heat  make  a  positive  requisition  upon  the  nutri- 
ment taken  into  the  system  for  enough  material 
from  which  is  developed  the  heat  necessary  to  main- 
tain the  required  degree  of  temperature.  This 
amount  they  must  have,  and  that  which  remains,  be 
it  much  or  little,  is  appropriated  for  growth  and  the 
renovation  of  the  tissues  that  are  wasted.  When 
the  body  is  not  sufficiently  clad,  there  is  a  loss  by 
radiation  of  a  certain  amount  of  heat,  a  lowering  of 
the  surface  temperature.  This  necessitates  an  extra 
effort  of  the  system  to  supplement  the  heat  that  has 
been  lost  in  order  to  preserve  the  proper  standard, 
and  an  expenditure  of  material  wh^h  could  other- 


PROTECTION  OF  THE  BODY.  41 

wise  have  gone  to  build  up  the  frame  and  strength- 
en the  tissues  of  the  body.  Should  this  expenditure 
continue  for  any  length  of  time,  the  result  would 
be  a  body  small  in  size,  or  inferior  in  texture,  or 
both. 

Inasmuch  as  but  a  definite  amount  of  food  can 
be  taken  into  the  body,  and  from  this  all  the  animal 
heat  must  be  developed,  as  well  as  all  the  material 
for  growth  obtained,  it  is  of  the  greatest  importance 
that  the  body  should  be  thoroughly  protected  dur- 
ing the  maturing  years,  so  that  the  growing  tissues 
may  not  be  deprived  of  their  full  share  of  nutriment 
through  any  unnecessary  call  for  material  in  the  for- 
mation of  heat.  Liebig  says,  "  Our  clothing  is,  in 
reference  to  the  temperature  of  the  body,  merely  an 
equivalent  for  a  certain  amount  of  food."  When 
the  body  is  insufficiently  clothed,  the  nerve-force  is 
in  a  measure  exhausted  in  its  efforts  to  maintain  the 
normal  temperature,  and  in  consequence  there  is  a 
depression  or  loss  of  vitality,  with  a  resulting  disturb- 
ance of  all  the  functions,  in  addition  to  a  defective 
nutrition  of  the  tissues.  In  other  words,  cold  is  a 
powerful  nerve  depressor. 

The  blood  is,  moreover,  driven  by  the  cold  from 
the  surface  of  the  body  to  the  inner  organs,  produc- 
ing in  them  a  low  form  of  congestion  and  an  added 


4:2  HYGIENE  OF  CHILDHOOD. 

impairment  of  their  functions.  The  excretory  glands 
of  the  skin  are  also  hindered  in  their  duty  through 
insufficient  protection.  It  is  to  be  borne  in  mind 
that  the  skin  excretes,  or  allows  to  pass  through  it, 
a  large  amount  of  waste  or  used-up  material.  In 
the  adult  from  one  to  two  and  a  half  pints  of  fluid, 
containing  effete  or  deleterious  matter,  pass  through 
the  glands  of  the  skin  every  twenty-four  hours.  It  is 
computed  that  there  are  no  less  than  seven  million 
respiratory  glands  on  the  surface  of  the  body  of  an 
adult  of  ordinary  size,  and  that  these  glands,  if  placed 
end  to  end,  would  cover  a  distance  of  nearly  twenty- 
eight  miles.*  In  the  child  there  is  naturally  a  smaller 
number  of  glands.  Proportionately  to  its  size,  how- 
ever, the  skin  of  a  child  excretes  more  fluid  than 
that  of  the  adult.  Now,  if  the  skin  is  not  properly 
protected,  the  blood  which  carries  the  waste  mate- 
rial to  the  glands  is  driven  from  the  surface,  and  the 
waste  material  must  find  its  way  out  of  the  system 
through  some  other  organ,  and  in  so  doing  over- 
taxes this  organ  and  renders  it  liable  to  disease. 
This  used-up  or  effete  matter  is  also  retained  in  the 
circulating  fluid,  the  blood,  longer  than  it  should  be, 
and  consequently  helps  to  vitiate  the  system  and  to 

*  Carpenter's  "  Physiology." 


PROTECTION  OF  THE  BODY.  43 

render  it  more  liable  to  bowel  and  lung  trouble,  dis- 
ordered digestion,  and  disease  in  general 

"When  the  infant  emerges  from  babyhood,  at  two 
and  a  half  years,  as  it  begins  to  run  about  and  show 
off  its  pretty,  attractive  little  ways,  mothers  are  very 
apt  to  forget  the  importance  of  warmth  and  thorough 
protection  of  the  body,  and  are  led  to  indulge  their 
fondness  for  pretty  effects  by  dressing  the  little  one 
too  often  in  short  socks,  thereby  leaving  the  legs  ex- 
posed. From  the  second  to  the  fifth  year  many 
children  are  very  imperfectly  protected.  Let  me 
urge  all  who  have  anything  to  do  with  children 
during  this  period,  to  see  that  the  whole  body 
is  thoroughly  protected.  Long  stockings  should  be 
worn  throughout  the  whole  year,  and  merino  drawers 
and  high-neck,  long-sleeved  under-shirts  during  the 
colder  months  of  autumn,  winter,  and  spring.  The 
same  care  throughout  the  whole  period  of  childhood 
is  necessary  for  the  foundation  of  vigorous  health. 
Wool  is  a  poor  conductor  of  heat,  and  keeps  the 
body  warm  by  preserving  about  it  the  heat 
formed  within.  Linen  and  cotton,  on  the  other 
hand,  are  good  conductors  of  heat,  and  allow  its 
rapid  escape.  When  garments  of  wool  are  worn 
next  to  the  skin,  there  is  less  susceptibility  to  the 
shock  of  any  sudden  atmospheric  change,  than 


44:  HYGIENE  OF  CHILDHOOD. 

when  linen  or  cotton  is  worn.  There  is  also  a 
greater  equilibrium  of  the  circulation  and  a  more 
harmonious  working  of  the  inner  organs.  Woolen 
under-garments,  moreover,  stimulate  the  surface  by 
friction,  and  assist  by  this  means  in  maintaining  a 
healthier  condition  o±  the  skin,  and  prevent  the 
too  rapid  cooling  of  the  body  when  heated  from 
physical  exercise. 

The  receipt  of  the  celebrated  physician,  Dr.  John 
Hunter,  for  rearing  healthy  children,  was  "  plenty  of 
sleep,  plenty  of  milk,  and  plenty  of  flannel." 

The  variability  of  the  climate  of  the  North  At- 
lantic States  calls  for  close  attention  to  the  protec- 
tion of  the  body.  The  sudden  alternation  of  heat 
and  cold,  which  is  characteristic  of  most  of  our  cli- 
mate, is  a  prolific  cause  of  illness,  which  is  not 
brought  about  through  breathing  the  colder  air — as 
many  suppose — but  is  induced  by  the  change  of 
temperature  from  warmer  to  colder  air,  creating  a 
sudden  revulsion  of  the  cutaneous  circulation,  and  a 
consequent  congestion  of  the  internal  organs.  Any- 
thing, therefore,  which  will  prevent  this  revulsion  of 
the  surface  circulation  will  be  instrumental  in  pre- 
serving health.  In  merino  and  other  woolen  un- 
derwear we  have  the  best  means  for  accomplishing 
this  object. 


PROTECTION  OF  THE  BODY.  45 

If  this  thorough  protection  is  enforced,  there 
will  be  fewer  cases  of  consumption  and  nerve  de- 
pression in  after-life.  Through  cold  a  shock  is 
often  given  which,  although  not  appreciated  at  the 
time,  produces  an  effect  later.  Like  the  tender 
plant  put  out  too  early  in  the  spring,  and  affected 
by  the  spring  frost,  it  may  still  grow,  but  it  is 
stunted  and  unproductive,  or,  if  productive,  its  fruit 
is  not  so  abundant  or  large  as  that  from  the  plant 
which  has  received  more  protection  in  early  life. 
The  laws  of  growth  and  life  are  the  same  in  the 
animal  as  in  the  vegetable  kingdom. 

The  necessity  of  suitable  clothing  for  the  young 
has  been  very  pointedly  exemplified  in  the  case  of  a 
little  child,  two  and  a  half  years  of  age,  who  has  re- 
cently been  under  my  care.  During  the  summer, 
the  child  was  the  picture  of  health  and  beauty. 
Late  in  the  autumn  I  was  consulted  by  the  mother, 
who  was  very  anxious  about  her  little  daughter.  I 
found  the  child  thin  and  pale,  her  ears  of  a  waxy 
color.  She  was  peevish,  wakeful  at  night,  with 
small  appetite,  disordered  digestion,  bowels  at  times 
constipated  and  frequently  much  relaxed.  She  was 
dressed — but  how?  Her  arms  were  covered  with 
very  thin  stuff,  feet  clothed  with  short  socks  and 
slippers,  while  the  legs  were  bare  for  two  thirds  of 


46  HYGIENE  OF  CHILDHOOD. 

their  length.  The  only  remedy  prescribed  was 
warm  stockings  long  enough  to  cover  the  whole  leg, 
merino  drawers,  and  long-sleeved  undershirt.  The 
result  was  that,  after  the  lapse  of  a  month,  the 
child's  health  and  beauty  were  restored.  This  is 
not  an  uncommon  experience.  Many  children  are 
kept  in  a  fretful  condition,  are  pallid,  with  defective 
appetite  and  digestion,  and  thousands  more  are  sent 
to  their  graves,  all  owing  to  the  exposure  of  arms 
and  legs  indoors  as  well  as  out-of-doors  during  the 
spring,  autumn,  and  winter.  I  could  narrate  case 
after  case  where  health,  happiness,  and  brightness 
have  been  restored  by  simply  clothing  the  child  in 
woolen  under-garments,  and  protecting  the  feet  with 
warm  shoes.  The  danger  to  the  system,  resultant 
from  imperfectly  protected  feet  and  legs,  is  greater 
than  most  mothers  realize.  The  sole  of  the  foot  is 
freely  supplied  with  an  interlacing  of  blood-vessels, 
by  means  of  which  the  whole  systemic  circulation 
can  be  chilled  and  affected  if  the  foot  is  not  amply 
protected.  When  the  bottom  of  the  foot  has 
merely  a  thin  piece  of  leather  between  it  and  the 
cold,  damp  ground,  there  must  take  place  a  revul- 
sion of  the  circulation,  the  blood  is  driven  back  to 
the  central  organs,  creating  in  them  some  disorder, 
and  an  increased  duty  is  demanded  of  the  nervous 


PROTECTION  OF  THE  BODY.  4? 

system  to  keep  up  the  proper  equilibrium  of  the 
blood-current.  The  shoe,  therefore,  should  be  thick 
enough  to  protect  the  foot  from  cold  and  exclude 
the  dampness.  Every  boy,  and  perhaps  girl  also, 
must,  as  the  natural  result  of  active  play  have,  at 
times,  wet  feet — one  of  the  unavoidable  risks  of 
childhood.  It  is  important,  however,  to  impress 
upon  the  child  the  necessity  of  quickly  changing 
shoes  and  stockings  when  they  become  wet  or 
damp. 

The  appearance  of  a  child  is  too  often  the  domi- 
nant thought,  rather  than  that  the  manner  of  dress- 
ing it  should  be  conducive  to  health.  With  its 
pretty  white  frock,  short  socks,  and  slippers,  display- 
ing its  bare  legs,  the  child  is  a  pleasing  picture  for 
some  mothers  to  look  upon.  When  the  doctor  pro- 
tests against  all  this,  he  is  too  often  met  with  a 
frown,  and  the  change  is  objected  too.  "  The  child 
looks  so  pretty  with  short  socks  and  bare  legs,"  is 
one  of  the  stereotyped  replies.  The  custom  of  bar- 
ing the  legs  is  one  that  has  been  handed  down,  and 
accepted  by  each  generation  of  mothers  as  the 
proper  manner  of  dressing,  without  considering  the 
evil  that  may  arise  therefrom.  When  reminded  of 
the  danger,  they  advance  the  argument  that  "  the 
child's  legs  become  accustomed  to  the  cold,  and 


48  HYGIENE  01'  CHILDHOOD. 

do  not  feel  it,"  or  that  "  they  wish  to  accustom 
the  child  to  cold,  and  make  him  tough  and 
hardy." 

It  must  be  remembered  that  there  is  a  marked 
difference  between  the  temperature  near  the  floor, 
where  the  child  may  be  playing,  and  of  that  sev- 
eral feet  higher,  where  the  parent  is  sitting  or  stand- 
ing in  comfort.  "Would  the  mother  be  willing  to 
lie  flat  on  the  floor  for  any  length  of  time  ?  Would 
not  the  fear  of  taking  cold  prevent  her  from  expos- 
ing her  head  to  the  draught  on  the  floor?  Yet  the 
child's  tender  legs,  if  they  are  unprotected  by  long 
stockings,  are  exposed  to  the  same  draughts  which 
she  fears  would  give  her  a  cold  in  the  head.  Many 
of  the  colds  and  little  ailments  of  young  children,  the 
causes  of  which  are  such  a  mystery  to  the  mother, 
who  has  been  "  so  careful,"  are  the  result  of  taking 
cold  while  playing  on  the  floor  near  the  base-board 
of  the  room,  or  near  the  window,  even  though  it  be 
shut,  or  near  the  door,  under  which  there  is  gener- 
ally a  space  through  which  the  air  blows.  A  cur- 
rent of  air  blowing  through  a  crack,  or  along  one 
plane,  as  the  current  of  air  along  the  floor,  is  more 
dangerous  to  health  than  if  one  is  in  a  colder  air 
which  is  blowing  equally  about  the  body.  It  is 
well  to  bear  in  mind  the  wise  old  saying  : 


PROTECTION  OF  THE  BODY.  49 

"  If  the  wind  strikes  you  through  a  hole, 
Go  count  your  beads  and  mind  your  soul." 

The  impression  that  the  effect  of  cold  is  shown 
chiefly  in  some  disorder  of  the  air-passages  is  so 
prevalent,  that  I  wish  to  emphasize  the  fact  that 
the  lungs  and  the  air-passages  to  the  lungs  are  by 
no  means  as  frequently  or  as  seriously  affected  by 
chill  to  the  surface  of  the  body  and  to  the  extremi- 
ties, as  are  the  organs  of  digestion  and  the  nervous 
system.  The  nervous  system  is  prostrated,  so  to 
speak,  in  its  effort  to  maintain  the  equilibrium  of 
the  circulation  when  disturbed  by  cold.  A  chill  to 
the  surface  of  the  body  is  a  most  prolific  cause  of 
disorder  of  the  digestion,  arresting  the  function  of 
the  liver,  and  bringing  about  the  accompanying 
symptoms  of  loss  of  appetite,  diarrhoea,  colic,  and 
want  of  nutrition,  all  of  which  very  frequently  take 
place,  without  the  child  showing  any  of  the  effects 
of  cold  by  sneezing  or  coughing. 

The  physiological  effect  of  cold  is  the  same, 
whether  the  individual  experiences  the  sensation  or 
not.  The  nerves  of  sensation  at  the  surface  of  the 
skin  may  be  blunted  from  habitual  exposure  just  as 
the  stomach  of  the  drunkard  may  be  tolerant  of  an 
enormous  amount  of  alcoholic  liquor ;  but  does  any 
one  imagine  that  an  excessive  quantity  of  alcoholic 


50  HYGIENE  OF  CHILDHOOD. 

liquor  taken  into  the  stomach  is  not  damaging  to 
the  system  ?  One  may  have  greater  resistance  to 
the  effect  of  cold  than  another,  but  in  the  exercise 
of  this  resistance  there  is  a  waste  of  nerve  energy 
and  a  loss  of  force  which  should  be  held  in  reserve 
to  supply  the  demands  that  the  system  will  make 
upon  it  in  the  time  of  illness. 

In  one's  zeal  that  the  child  may  be  thoroughly 
protected  from  cold  there  is  the  possibility  of  erring 
on  the  other  side,  and  that,  by  being  too  much  and 
too  heavily  clad,  a  tenderness  and  delicacy  of  the 
body  may  be  induced,  with  a  liability  to  sudden 
colds  from  slight  changes  of  temperature.  A  child 
of  from  two  to  four  or  five  years  of  age,  if  in  good 
health,  is,  I  might  say,  never  quiet  during  waking 
hours.  Its  ceaseless  motion  increases  the  naturally 
active  circulation,  and  induces  free  perspiration. 
The  clothing,  therefore,  should  be  of  light  but 
warm  material,  such  as  will  permit  the  perspiration 
to  evaporate  freely  without  the  danger  of  incurring 
a  chill. 

Suitable  clothing  for  outdoor  wear  is  also  an 
important  consideration,  especially  so  for  boys  dur- 
ing the  winter.  "  Young  America  "  is  prone  to  ex- 
ercise a  great  deal  of  independence  in  dress.  He 
imagines  that  the  overcoat  is  an  unnecessary  article 


PROTECTION  OF  THE  BODY.  51 

of  apparel,  and  that  going  without  it  is  the  means 
of  gaining  a  tough  and  hardy  constitution.  The 
evils  resulting  from  this  idea  are  too  frequently 
brought  to  the  notice  of  the  physician.  I  have 
frequently  witnessed  a  great  improvement  in  a 
boy's  health,  and  known  the  tendency  toward  colds 
and  snuffles  to  be  broken  up,  after  the  boy  has  been 
compelled  to  wear  an  overcoat  during  the  winter 
months.  Persistent  disuse  of  it  is  often  the  cause 
of  catarrhal  troubles,  pallor  of  countenance,  and  the 
want  of  development  of  fat.  It  is  equally  impor- 
tant that  girls  should  be  clad  with  thick  jackets  and 
gowns. 

The  mother  should  satisfy  herself  that  her 
daughter's  clothing  is  not  too  tight  about  the  waist. 
The  effect  of  tight  lacing  is  disastrous  enough  with 
fully  developed  women  ;  the  results  are  far  more 
serious  with  the  child.  At  this  period  the  lungs 
are  naturally  increasing  in  size  in  conformity  with 
the  development  of  the  rest  of  the  body,  and  their 
full  power  of  expansion  should  be  permitted,  in 
order  that  sufficient  oxygen  may  be  taken  into  the 
system,  and  a  due  amount  of  waste  material  carried 
out  through  the  lungs.  The  full  exercise  of  the 
functions  of  the  liver,  stomach,  and  upper  bowels  is 
also  necessary  to  healthy  nutrition  of  the  body.  All 


52  HYGIENE  OF  CHILDHOOD. 

these  duties  are  interfered  with  if  the  clothes  are 
worn  too  tight  about  the  waist.  When  corsets  are 
worn  at  too  early  an  age,  or  when  laced  too  tightly, 
they  press  upon  the  lower  ribs,  compressing  the 
base  of  the  lungs,  and  prevent  their  full  expansion. 
The  liver  and  stomach  are  also  compressed,  their 
cell-life  is  interfered  with,  and  the  organs  them- 
selves become  contracted.  This  retards  the  pres- 
ent as  well  as  future  development  of  health  and 
strength,  and  constipation  and  uterine  troubles,  re- 
sulting from  disturbance  of  the  abdominal  circula- 
tion and  the  downward  pressure  of  the  bowels,  are 
among  the  probable  evils. 

The  skirts  and  under-garments  of  young  girls 
should  be  supported  by  shoulder-straps  or  skirt- 
supporters,  in  order  to  avoid  undue  pressure  about 
the  abdomen,  and  the  downward  pressure  into  the 
pelvis,  that  must  occur  when  these  garments  are 
simply  held  in  place  by  tight  bands  about  the 
waist. 

A  grave  mistake  is  frequently  made  in  night- 
clothing  of  children.  Even  careful  mothers,  who  ap- 
preciate the  importance  of  woolen  garments  during 
the  day,  will  often  clothe  the  child  at  night  in  a  simple 
cotton  night-dress,  without  the  woolen  under-shirt. 
This  is  most  unadvisable.  During  the  sleeping- 


PROTECTION  OF  THE  BODY.  53 

hours  the  circulation  is  more  feeble,  and  the  vitality- 
is  lower.  The  skin  requires,  therefore,  careful  pro- 
tection at  this  time,  in  order  to  maintain  an  equi- 
librium of  the  circulation.  Linen  shirts  should  be 
discarded  during  the  fall,  winter,  and  spring,  and 
even  during  the  summer  when  at  the  sea  shore,  at 
which  time  the  child  should  wear  some  kind  of 
woolen  under-shirt.  Yerj  young  children  may  wear 
flannel  or  canton-flannel  combination  suits.  xThe  in- 
sensible perspiration  which  is  constantly  thrown  off 
carries  with  it  an  amount  of  waste  material  which 
is  rubbed  off  the  skin  and  retained  in  the  under- 
flannel  or  clothing.^  The  under-garments  worn  dur- 
ing the  day,  therefore,  should  be  changed  at  bed- 
time, so  that  this  noxious  matter  may  be  destroyed 
or  disinfected  by  exposure  to  the  air.  For  the  same 
reason,  also,  fresh  under-clothing  should  be  put  on 
several  times  a  week. 

When  we  consider  that  about  one  third  of  an 
adult's  life  and  nearly  one  half  of  a  young  child's 
life  are  passed  in  bed  and  sleep,  the  immediate  sur- 
roundings of  the  individual  during  that  time,  are 
matters  of  no  small  consideration. 


54:  HYGIENE  OF  GUILD  HOOD. 

IMPORTANCE  OF  PURE  AIR. 

The  importance  of  pure  air  and  the  great  dan- 
ger of  foul  air  in  the  house,  in  its  effects  upon  chil- 
dren, are  not  always  fully  appreciated.  Pure  air 
is  as  necessary  as  good  food,  for  the  oxygen  in 
it  is  as  distinctly  an  article  of  nutriment.  With- 
out the  necessary  supply  of  oxygen  a  sufficient 
number  of  blood-corpuscles  can  not  be  formed,  and 
in  consequence  the  healthy  growth  of  tissue  can 
not  take  place.  When,  therefore,  the  air  taken 
into  the  lungs  does  not  contain  the  full  supply  of 
oxygen,  as  in  the  case  where  there  is  defective 
ventilation,  the  system  is  deprived  of  due  nutri- 
tion, a  starvation  of  tissue  is  the  result ;  develop- 
ment is  retarded,  and  there  is  a  lack  of  physical 
strength. 

The  sense  of  smell,  and  the  effect  that  the  air 
has  upon  the  ease  of  breathing  and  general  com- 
fort, are  as  a  rule  sufficient  guides  as  to  its  purity. 
With  many  individuals,  however,  this  can  not  be 
relied  upon,  for  their  faculty  of  detecting  an  impure 
atmosphere  is  blunted,  from  their  breathing  it  so 
continuously.  If  upon  entering  a  house  or  a  room 
there  is  the  slightest  odor  perceptible,  one  may  feel 
assured  that  there  is  insufficient  ventilation  and  that 


IMPORTANCE  OF  PURE  AIR.  55 

the  air  is  vitiated,  and  therefore   detrimental   to 
health. 

The  sources  of  air  pollution  or  vitiation  in  the 
house  are  defective  plumbing,  burning  of  gas,  the 
gas  given  off'  from  defective  furnaces  and  stoves, 
cellars  that  are  damp  or  that  contain  rotted  wood 
or  undue  amount  of  vegetable  matter,  exhalations 
from  the  body  and  lungs,  and  lastly  house  filth. 
The  unsanitary  condition  of  the  house,  permitting 
foul  odors  from  the  drains  or  water-closet  to  con- 
taminate the  air  the  child  breathes,  will  devitalize 
the  system,  poison  the  nerve-centers,  and  exercise  a 
baneful  effect  upon  the  growth  and  health.  If  the 
air  is  loaded  with  decomposing  material  from  drains, 
or  is  vitiated  by  want  of  proper  ventilation,  the 
child  will  display  all  the  symptoms  manifested  by 
children  who  have  poor  food  and  an  insufficient 
amount  of  sleep;  such  as  pallor  of  countenance, 
headache,  loss  of  appetite,  want  of  energy,  and 
general  depression.  Breathing  impure  air  is  also  a 
prolific  cause  of  catarrhal  colds  and  sore  throats ;  it 
predisposes  a  child  to  tonsillitis,  bronchitis,  and 
pneumonia ;  and  as  a  result  of  lowered  vitality 
there  is  less  power  of  resistance  to  the  contagious 
diseases,  such  as  scarlet  fever,  diphtheria,  etc.  The 
air  of  the  nursery  or  bedroom  is  frequently  ren- 


56  HYGIENE  OF  CHILDHOOD. 

dered  unwholesome  by  burning  too  much  gas.  It 
must  be  borne  in  mind  that  -one  ordinary  gas- 
burner  consumes  as  much  oxygen  or  vitiates  as 
much  air  as  five  people;  so  that,  if  the  gas  has 
been  burning  for  any  length  of  time  in  a  sleeping- 
room,  fresh  air  from  out  of  doors  should  be  ad- 
mitted before  retiring  for  the  night.  So,  too,  fresh 
air  should  always  be  admitted  when  the  nursery  has 
been  used  as  a  sitting-room  or  a  play-room  during 
the  afternoon,  for  the  atmosphere  becomes  polluted 
by  the  exhalations  from  the  lungs. 

The  used-up  material  thrown  out  of  the  system 
through  the  lungs  and  from  the  surface  of  the  body, 
and  which  consists  chiefly  of  carbonic  acid  gas  and 
organic  matter,  is  a  constant  source  of  air  pollution. 
The  carbonic-acid  gas  was  formerly  considered  to  be 
the  most  dangerous  of  air  impurities,  but  we  now 
know  that  the  organic  matter  carried  out  with  the 
breath  and  with  the  perspiration  is  far  more  deleteri- 
ous. This  product  is  an  actual  poison  of  a  virulent 
character,  as  has  been  shown  by  the  investigations  of 
Prof.  Brown-Sequard.  In  condensing  the  watery 
vapor  coming  from  the  human  lungs  he  obtained 
a  poisonous  liquid  capable  of  producing  almost  im- 
mediate death.  He  injected  the  liquid  under  the 
skin  of  a  rabbit,  and  the  effect  was  speedily  fatal. 


IMPORTANCE  OF  PURE  AIR.  57 

When  the  organic  poison  coming  out  of  the 
lungs  is  rebreathed,  the  individual  is  subjected  to  a 
process  of  slow  poison,  which,  although  not  fatal,  is 
steadily  undermining  the  functions  of  life. 

This  organic  matter  does  not  long  remain  in  sus- 
pension in  the  air  of  the  room  ;  its  weight  causes  a 
large  portion  to  settle  upon  the  floor  and  furniture, 
and  a  certain  amount  adheres  to  the  walls'.  The 
accumulations  of  these  solid  exhalations  from  the 
lungs  and  skin,  that  must  necessarily  take  place  in  a 
room  or  house  where  there  is  insufficient  cleanliness 
or  imperfect  ventilation,  constitute  a  great  part  of 
house  pollution,  or,  as  I  have  elsewhere  termed  it, 
"  house  filth,"  and  give  rise  to  that  peculiar  stuffy, 
disagreeable  smell  so  noticeable  in  some  houses. 

Investigation  shows  that  from  this  organic  mat- 
ter are  developed  minute  organisms  or  low  forms  of 
fungoid  life,  and  that  the  number  of  these  organ- 
isms will  vary  according  to  the  amount  of  this  house 
filth.  It  has  also  been  demonstrated  that  the  state 
of  health  of  the  inmates  of  the  house  largely  de- 
pends upon  the  number  of  these  micro-organisms, 
and  that  in  times  of  epidemics  a  greater  percentage 
of  deaths  occurs  in  houses  where  there  is  a  greater 
amount  of  this  foul  air.  The  term  "  house  filth  "  is 
perhaps  an  objectionable  one  to  many,  who  are  not 


58  HYGIENE  OF  CHILDHOOD. 

aware  of  the  existence  of  this  organic  matter,  or 
who  do  not  realize  the  danger  that  arises  from  its 
settling  upon  the  furniture,  from  its  being  retained 
in  mattresses  that  are  seldom  picked  over  or  cleaned, 
from  its  mingling  with  the  dust  accumulated  be- 
hind and  under  the  furniture,  and  from  remaining 
on  the  carelessly  swept  or  unwashed  floors.  Dirty 
carpets  become  receptacles  of  organic  matter  and  hot- 
beds for  breeding  the  low  organisms.  These  micro- 
organisms, when  taken  into  the  lungs,  devitalize  the 
system,  and  are  one  of  the  great  causes  of  lowered 
vitality,  inducing  the  symptoms  already  enumer- 
ated. Careless  housekeepers  are  generators  of  un- 
healthy households. 

The  only  way  to  remove  and  to  keep  away  this 
organic  deposit,  which  exists  wherever  human  be- 
ings dwell,  is  by  great  cleanliness,  frequent  scrub- 
bing, wiping  down  the  walls,  vigorous  sweeping, 
shaking  the  carpets,  dusting,  and  the  free  admis- 
sion, winter  and  summer,  of  the  outside  air. 

The  healthfulness  of  the  nursery  is  greatly  pro- 
moted by  hard -wood  floors,  covered  with  rugs, 
which  may  be  taken  up  frequently  and  shaken. 
Thorough  cleanliness,  therefore,  as  well  as  ventila- 
tion, is  necessary  to  maintain  in  the  house  pure  air 
which  is  imperative  for  every  child  to  breathe.  It 


IMPORTANCE  OF  PURE  AIR.  59 

would  seem  almost  unnecessary  to  speak  of  the  im- 
portance of  opening  the  windows  of  the  bedroom 
in  the  morning,  but  experience  proves  that  it  is  often 
neglected  during  the  winter  months,  even  in  house- 
holds where  fair  attention  is  paid  to  the  laws  of 
health.  The  windows  of  an  occupied  bedroom 
should  be  left  wide  open  for  a  time  every  morning, 
and  the  bedclothes  thoroughly  exposed  to  the  fresh 
air.  The  impurities  in  the  air  are  not  as  quickly 
appreciated  when  the  air  is  cold  as  when  it  is  mod- 
erately warm,  and,  owing  to  this,  a  cold  room  is  very 
apt  to  escape  perfect  ventilation. 

The  night  ventilation  of  the  child's  bedroom  is 
often  difficult  to  accomplish  satisfactorily  without 
creating  a  draught.  Yet  it  is  a  matter  of  great  im- 
port, when  we  consider  that  nearly  one  half  of  the 
life  of  a  young  child  is  spent  in  bed.  The  wide- 
spread delusion  that  a  child  should  sleep  in  a  cold 
room,  and  that  the  windows  should  be  widely  open, 
is  productive  of  great  harm.  If  the  room  is  too 
cold,  an  extra  amount  of  bedclothing  is  necessary. 
This  additional  covering,  by  preventing  evaporation, 
retains  about  the  body  the  exhalations  from  the 
skin,  and  the  heavy  clothing  tends  to  impede  free 
breathing  as  well  as  to  prevent  such  a  peaceful  and 
restful  sleep  as  when  the  covering  is  light.  If  the 


60  HYGIENE  OF  CHILDHOOD. 

covering  is  too  thick,  the  child  after  falling  asleep 
is  very  apt  to  break  out  into  a  perspiration.  This 
creates  a  restlessness,  the  bedclothes  are  partially 
thrown  off,  exposing  the  surface  of  the  body  to  the 
cold  night  air,  and  to  the  risk  of  those  evils  to  which 
I  have  already  alluded  when  children  are  too  thinly 
clad.  In  heavy  sleep  the  sensation  of  cold  is  not 
experienced,  but  the  injurious  effects  follow  never- 
theless. The  temperature  of  the  room,  therefore, 
should  not  be  cold  enough  to  necessitate  heavy  cov- 
ering. Cotton  sheets  and  light  blankets  are  the 
only  covering  suitable  for  a  child  at  night.  Com- 
forters of  down  or  cotton  do  not  permit  the  ready 
evaporation  of  the  insensible  perspiration,  and  are 
not,  therefore,  as  healthful  as  blankets.  During 
very  cold  weather  it  is  desirable  to  ventilate  the 
bedroom  at  night  through  another  room,  or  by 
means  of  a  door  leading  into  the  hall,  where  a  win- 
dow may  be  left  open,  so  that  the  air  may  be  tem- 
pered before  reaching  the  room.  During  moderate 
weather  the  bedroom  window  may  be  left  open  a 
short  distance  from  the  top.  Some  means  should 
always  be  provided  for  the  exit  of  foul  and  the  en- 
trance of  pure  air. 

It  is  impossible  to  prescribe  the  details  of  venti- 
lation for  the  bedroom,  for  the  directions  must  natu- 


IMPORTANCE  OF  PURE  AIR.  61 

rally  vary  according  to  the  size  and  position  of  the 
room  and  the  condition  of  the  atmospheric  tempera- 
ture. While  calling  attention  to  the  very  great  im- 
portance of  pure  air  in  the  bedroom,  I  only  desire  to 
emphasize  the  danger  of  too  cold  a  room.  I  am 
aware  that  some  physicians  advocate  sleeping  in 
very  cold  rooms.  I  fail,  however,  to  see  the  neces- 
sity or  reason,  from  a  hygienic  standpoint,  for  so 
doing.  If  toughening  the  child  is  the  motive,  it  is 
certainly  a  mistaken  one ;  if  fresh  air  is  the  object, 
this  should  be  accomplished  if  possible  without  low- 
ering the  temperature  too  much.  The  temperature 
in  the  sleeping-room  of  a  child  over  three  years  of 
age,  evincing  no  sign  of  lung  trouble,  should  be  be- 
tween 50°  and  60°  Fahr.  With  this  degree  of  tem- 
perature, pure  air  in  the  room,  and  not  too  heavy 
bed-covering,  the  sleeper  will  awaken  in  the  morn- 
ing, after  a  restful  sleep,  without  any  injury  to 
health. 

Many  devices  are  resorted  to  for  allowing  fresh 
air  to  enter  .through  a  window  without  creating  a 
draught ;  only  two  of  which,  on  account  of  the  ease 
of  application  and  efficacy,  I  will  mention. 

The  one  I  would  especially  recommend  is  as  fol- 
lows :  A  frame  should  be  made  about  twelve  inches 
high,  and  of  a  width  sufficient  to  fit  in  the  window- 


62  HYGIENE  OF  CHILDHOOD. 

frame  ;  on  this  should  be  tacked  coarse  muslin,  or, 
if  preferred,  loosely  woven  colored  cloth.  The 
upper  sash  is  then  lowered  sufficiently  to  insert  the 
prepared  frame  at  the  top.  This  device  is  largely 
used  in  hospitals,  and  permits  fresh  air  to  come  in 
without  creating  a  draught,  and  also  excludes  the 
dust. 

The  other  method  recommended  is  the  placing 
a  strip  of  wood  six  inches  broad  under  the  whole 
length  of  the  lower  sash,  which,  by  being  raised, 
permits  a  current  of  air  to  enter  between  it  and  the 
upper  sash,  and,  when  the  window-shade  is  raised, 
directs  the  current  upward  toward  the  ceiling  and 
lessens  the  danger  of  air  blowing  upon  those  who 
may  be  in  the  room. 

An  open  fireplace,  even  without  a  fire,  is  a  great 
aid  in  promoting  good  ventilation,  and  is  desirable 
to  have  in  every  bed-room.  Where  the  sleeping- 
room  is  small,  without  a  fireplace,  it  is  impossible 
to  secure  pure  air  in  it  throughout  the  night  unless 
a  window  or  door  is  open.  If  the  choice  lies  be- 
tween having  the  bedroom  air  of  moderate  temper- 
ature rendered  impure  by  bad  ventilation,  and  cold 
with  good  ventilation,  it  is  far  better  to  have  the  air 
cold  and  pure,  and  covering  the  sleeper  with  the 
objectionable  heavy  clothing. 


IMPORTANCE  OF  PURE  AIR.  63 

The  sudden  and  great  change,  after  breathing 
during  the  day  the  overheated  air  that  is  found  in 
most  houses,  to  the  very  cold  air  inhaled  at  night 
while  sleeping,  when  the  circulation  and  vitality  are 
lowered,  induces  a  catarrhal  condition  or  a  conges- 
tion of  the  mucous  surfaces  of  the  air-passages. 

When  the  seat  of  this  catarrh  is  in  the  mucous 
membrane  of  the  nose,  free  respiration  through  the 
nose  is  interfered  with,  and  as  a  result  the  child  is 
compelled  to  breathe  through  the  mouth.  I  wish 
here  to  urge  the  great  importance  of  breathing 
through  the  nose  rather  than  through  the  mouth. 
The  configuration  of  the  inner  portion  of  the  nose 
is  such  that  a  large  amount  of  mucous  surface  is 
exposed.  This  warms  the  air  passing  over  it,  and 
protects  the  pulmonary  circulation  from  the  shock 
that  occurs  when  cold  air  is  breathed  directly  into 
the  lungs  through  the  mouth.  The  mucous  mem- 
brane covering  the  irregular  turbinated  bones  in  the 
nose  performs  another  important  duty :  it  collects 
and  retains  on  its  moist  surface  a  large  amount  of 
the  organic  and  inorganic  matter  floating  in  the  air, 
and  thus  prevents  this  material  finding  entrance  into 
the  lungs,  where  its  presence  is  a  source  of  irritation. 
Moreover,  the  air  in  its  passage  through  the  nose 
absorbs  more  or  less  moisture,  and  is  thereby  ren- 


64  HYGIENE  OF  CHILDHOOD. 

dered  more  acceptable  and  less  irritating  to  the  pul- 
monary organs.  Thus  we  see  that  the  nose  per- 
forms a  threefold  office,  viz.,  filtering  by  removing 
floating  particles,  warming  the  air,  and  giving 
moisture  to  the  air.  It  acts  as  a  vestibule  does  to 
a  house,  preventing  a  sudden  rush  of  cold,  dirty  air 
into  the  more  refined  apartments  within. 

Understanding  now  the  important  duties  per- 
formed by  the  nose,  the  injurious  consequences  that 
take  place  when  there  is  a  hindrance  to  the  full  ac- 
complishment of  its  functions  can  be  set  forth.  In 
order  that  a  sufficient  amount  of  air  may  enter  the 
lungs  for  the  purpose  of  purifying  the  blood,  the 
caliber  of  the  passage  through  which  the  air  passes 
in  must  be  of  proper  dimensions,  consequently  it  is 
highly  important  that  there  should  be  no  thickening 
of  the  nasal  mucous  membrane  to  diminish  the  cali- 
ber of  the  nasal  passage.  If  the  child  breathes 
through  the  nose  with  a  contracted  passage,  less 
oxygen  can  find  entrance  to  the  lungs  than  Nature 
intended,  and  there  results  an  imperfect  purification 
of  the  blood.  A  retention  of  the  impurities  affects 
the  general  health,  in  the  same  manner  as  already 
spoken  of  when  impure  air  is  breathed.  When  the 
air  is  taken  in  through  the  mouth,  its  low  tempera- 
ture, insufficiently  supplied  with  moisture,  and  hold- 


IMPORTANCE  OF  PURE  AIR.  65 

ing  in  suspension  an  amount  of  organic  and  inor- 
ganic matter,  lias  more  or  less  damaging  influence 
upon  the  pharynx  or  back  part  of  the  mouth  and 
the  lungs.  The  mucous  surface  of  this  portion  of 
the  breathing  apparatus  is  not  intended  to  with- 
stand the  harsh  influences  of  the  direct  air,  and, 
when  this  takes  place,  there  results  an  unhealthy 
or  catarrhal  condition  of  some  portion  of  the  mu- 
cous membrane,  and  the  individual  is  predis- 
posed to  acute  or  chronic  pharyngitis,  laryngitis, 
bronchitis,  pulmonary  congestion,  and  more  readily 
falls  a  victim  to  consumption.  A  mouth-breather 
is  rarely  a  strong,  healthy  being.  Mouth-breathing 
often  becomes  a  habit,  perhaps  started  by  an  influ- 
enzal  cold,  and  can  be  overcome  in  many  instances 
when  there  is  no  hypertrophy  of  the  mucous  sur- 
face, by  constantly  calling  the  attention  of  the  child 
to  breathing  through  the  nose.  One  of  the  chief 
causes  for  inducing  the  habit  of  mouth-breathing, 
aside  from  that  directly  caused  by  thickened  mu- 
cous membrane  of  the  nose,  is  the  impure,  over- 
heated house  air. 

The  North  American  Indians  have  so  clearly 
appreciated  in  a  practical  way  the  benefits  of 
breathing  through  the  nose,  that  they  early  habitu- 
ate their  children  to  its  practice.  The  Indian 


C6  HYGIENE  OF  CHILDHOOD. 

woman  watches  with  care  the  manner  of  breathing 
of  her  offspring.  If  the  mouth  is  open,  she  will 
gently  close  the  lips,  and  when  necessary  even 
bandage  them  in  order  to  compel  breathing  through 
the  nose.  If  we,  as  a  civilized  people,  would  but 
enforce  the  practice  of  the  Indians,  and  take  the 
pains  to  cultivate  this  habit  with  our  children, 
guarding  them  from  everything  which  may  devel- 
op nasal  catarrh,  an  important  factor  would  be  con- 
tributed to  the  more  perfect  development  of  our 
offspring. 

The  child  reared  under  the  conditions  imposed 
by  our  modern  manner  of  living  becomes  a  more 
sensitive  creature  and  is  more  easily  affected  by  at- 
mospheric changes  and  cold  air;  consequently,  he 
can  not,  while  asleep,  breathe  with  impunity  the 
cold  night  air,  as  can  the  Indian  child,  who  has  an 
inherited  vigor,  and  leads  a  mere  animal  existence. 
Civilization  and  refinement,  while  bringing  comfort 
and  pleasure  to  body  and  mind,  at  the  same  time 
impose  certain  penalties,  and  necessitate  a  much 
stricter  observance  of  the  laws  of  health. 

The  benefits  to  health,  accruing  from  free  ven- 
tilation and  pure  air,  are  constantly  exemplified 
in  cases  where  animals  are  herded  together.  Sta- 
tistics from  the  stables  of  the  French  army  show 


IMPORTANCE  OF  PURE  AIR.  67 

a  reduction  of  mortality  among  horses  of  from 
one  hundred  and  eighty  per  thousand  horses  to 
twenty  per  thousand  after  free  ventilation  had 
been  introduced.*  The  same  ratio  of  increased 
health  has  also  been  shown  in  factories  and  work- 
shops where  free  ventilation  and  cleanliness  are 
enforced.  Dr.  Parkes  gives  another  remarkable 
instance  illustrating  the  benefit  of  good  ventila- 
tion. He  mentions  the  fact  that  in  the  badly  venti- 
lated prison  of  Leopoldstadt,  Vienna,  51*4  per 
thousand  prisoners  died  from  consumption ;  while 
in  the  well-ventilated  house  of  correction,  in  the 
same  city,  the  mortality  from  the  same  disease  was 
T'9  per  thousand.  This  statement  should  arrest  the 
attention  of  those  in  whom  there  is  any  hereditary 
tendency  toward  pulmonary  trouble,  and  impress 
upon  them  the  great  necessity  of  having  good  house 
ventilation. 

To  preserve  the  purity  of  air  in  the  household, 
four  requirements  must  be  fulfilled  :  First,  the  ad- 
mission of  fresh  air  from  out-of-doors,  to  take  the 
place  of  the  air  which  is  constantly  being  vitiated 
wherever -animal  life  exists.  Second,  through  clean- 
liness, to  remove  from  the  furniture  and  floors  the 

*  "  Manual  of  Practical  Hygiene,"  by  E.  A.  Parkes,  M.  D.,  W. 
Wood  &  Co.,  Tol.  I,  p.  146. 


68  HYGIENE  OF  CHILDHOOD. 

organic  matter  which  is  constantly  thrown  off  from 
the  lungs  and  skin.  Third,  frequent  inspection  of 
plumbing.  Fourth,  a  cellar  free  from  all  dampness, 
rotting  wood,  and  everything  that  may  be  in  a  state 
of  decomposition.  We  might  add  another  requisite, 
viz..  to  see  that  stoves  and  furnaces  do  not  discharge 
that  most  dangerous  product  of  combustion,  car- 
bonic-oxide gas,  into  the  rooms.  If  there  is  a  crack 
in  the  furnace,  or  the  stove-damper  is  turned  off 
too  much,  this  gas  is  discharged  into  the  house, 
and  exerts  a  most  pernicious  effect  upon  all  who 
breathe  it. 

Having  already  commented  on  the  importance 
of  the  admission  of  fresh  air,  and  cleanliness,  I  will 
briefly  allude  to  the  other  requirements. 

The  plumbing  of  a  house  should  be  so  located 
that  it  can  be  thoroughly  inspected  without  disturb- 
ing the  plaster  and  wood-work,  and  it  is  certainly 
advisable  to  have  it  inspected  every  few  years. 
Sewer-gas  has  a  corroding  effect  upon  lead,  so  that 
a  lead  pipe  that  is  sound  one  year  may  be  perfo- 
rated with  holes  a  year  later.  In  modern  plumbing 
very  little  lead  pipe  is  used,  but  there  are  small  sec- 
tions of  this  pipe  employed  in  the  average  house.  It 
is  a  great  mistake  to  rely  upon  the  sense  of  smell,  in 
detecting  the  presence  of  cracks  and  openings  into 


IMPORTANCE  OF  PURE  AIR.  69 

soil-pipes,  for  some  of  the  most  dangerous  emana- 
tions from  these  pipes  are  scarcely  perceptible  by 
their  odor.  The  micro-organisms,  arising  from  the 
decomposing  organic  matter  adhering  to  the  in- 
terior walls  of  the  pipe,  are  not  particularly  offen- 
sive, and  yet  they  are  more  dangerous  in  their  effect 
upon  the  human  system  than  the  sewer-gases.  The 
germs  of  typhoid  fever,  scarlet  fever,  diphtheria,  and 
other  contagious  diseases,  may  find  entrance  into 
the  house  through  a  crack  or  fissure  in  the  pipe  that 
allows  the  entrance  of  sewer- gas. 

The  fourth  indispensable  condition  to  be  ob- 
served— i.  e.,  that  cellar  air  be  free  from  dampness 
and  germs  of  decomposition — is  one  that  is  not  gen- 
erally understood  or  appreciated,  even  by  those  who 
have  a  fair  knowledge  of  sanitary  matters.  During 
the  cold  weather,  when  the  doors  and  windows  are 
closed,  the  air  from  the  lower  floors  and  cellar  is 
drawn  upward,  by  the  current  of  heated  air  above. 
This  assertion  may  be  verified  by  pouring  on  the 
cellar  floor  a  small  quantity  of  oil  of  peppermint, 
when  the  odor  will  be  detected  in  a  few  minutes 
throughout  the  house.  Wherever  the  presence  of 
the  peppermint  is  detected,  there  impure  cellar  air, 
if  such  exist,  will  find  entrance. 

To  maintain  pure  air  in  the  cellar,  it  must  be 


70  HYGIENE  OF  CHILDHOOD. 

free  from  all  dampness,  free  from  all  rotted  wood, 
and  from  all  material  which  is  undergoing  decompo- 
sition. Wherever  there  is  confined  dampness,  there 
will  be  found  low  forms  of  vegetable  molds,  which, 
although  perhaps  not  visible  to  the  naked  eye,  are 
easily  shown  to  exist  by  the  aid  of  the  microscope. 
These  low  vegetable  organisms,  drawn  by  the 
heated  air  of  the  house  to  the  upper  floors,  and 
inhaled  by  the  inmates,  are  a  prolific  cause  of  the 
general  malaise  and  lowered  vitality  that  so  many 
suffer  from  while  living  in  houses  with  unsanitary 
and  especially  damp  cellars.  They  also  give  rise  to 
illnesses  simulating  malaria,  and  cause  quinine  to  be^ 
used  so  freely  in  many  households.  Sore  throats, 
bronchial  troubles,  and  a  condition  of  the  system 
calling  for  tonics,  are  also  of  frequenfrvoccurrence  in 
houses  with  damp  cellars.  Let  me  urge  all  those 
in  whose  families  there  is  a  taint  of  consumption 
to  be  especially  watchful  that  the  cellar  is  free  from 
all  dampness,  for  it  has  been  definitely  proved  that 
the  death  rate  from  consumption  is  greatly  dimin- 
ished if  the  subsoil  under  and  about  the  house  is  per- 
fectly dry.  In  a  report  of  an  investigation  of  drain- 
age of  one  hundred  and  twenty-eight  towns  in  Mas- 
sachusetts, Dr.  "Windsor  remarks,  in  regard  to  the 
influence  of  a  damp  soil  upon  the  health  of  persons 


IMPORTANCE  OF  PURE  AIR.  71 

living  over  it,  that  "  the  class  of  diseases  most  fre- 
quently noted  in  connection  with  damp  cellars  are 
inflammatory  diseases  of  the  respiratory  organs,  es- 
pecially bronchitis.  Next  in  order  of  frequency 
comes  rheumatism,  more  particularly  of  the  sub- 
acute  order.  Phthisis,  pneumonia,  and  wasting 
chronic  perversions  of  digestion,  are  also-  found 
by  many  of  our  correspondents  to  be  common  in 
houses  with  such  cellars ;  also  a  lessened  power  of 
resistance  to  all  diseases  when  contracted.  !No  ob- 
server can  doubt  that  a  large  amount  of  preventible 
disease  is  caused  by  damp  cellars."  * 

Every  parent  should  realize  the  vital  importance 
of  pure  air  for  a  growing  child,  and  should  endeavor 
to  keep  the  air  in  the  dwelling  as  pure  as  possible, 
especially  as  it  is  not  a  difficult  object  to  secure.  It 
only  necessitates  careful  and  intelligent  supervision 
of  the  requirements  mentioned,  and,  when  these  are 
observed,  the  reward  will  be  apparent  in  the  in- 
creased vigor  and  health  of  the  child. 

* "  Seventh  Annual  Report  of    the  Massachusetts    Board  of 
Health,"  p.  227. 


72  HYGIENE  OF  CHILDHOOD. 

EXERCISE. 

A  full  amount  of  exercise  in  the  open  air  is  one 
of  Nature's  requirements  for  healthy  development 
and  for  the  maintenance  of  a  good  state  of  health. 
Every  child,  therefore,  should  have  several  hours 
set  apart  daily  for  this  purpose,  that  its  energy  may 
find  free  vent  in  all  outdoor  sports.  Instinct  leads 
a  child  to  run,  climb,  jump,  and  freely  use  the 
voice.  All  this  strengthens  the  muscles  and  liga- 
ments, enlarges  the  breadth  of  the  chest,  improves 
the  digestion,  sharpens  the  appetite,  and  keeps  the 
functions  of  the  body  in  a  healthy  condition  ;  it  in- 
creases the  activity  of  the  circulation,  thereby  pro- 
moting the  exhalations  from  the  skin  and  lungs, 
thus  eliminating  from  the  system  the  used-up  or 
waste  material  floating  in  the  blood,  and  rendering 
the  mind  more  active.  When  the  weather  is  in- 
clement, the  recreation  and  play  should  be  indoors, 
but  out-of-doors  when  the  weather  permits;  for, 
added  to  the  exercise,  the  child  not  only  breathes 
pure  air,  but  derives  benefit  from  the  life-giving 
power  of  sunshine.  The  misshapen,  narrow,  and 
flat  chest  so  often  found  among  residents  of  cities  is 
largely  the  result  of  insufficient  exercise  of  the  arms 
and  chest  during  early  youth.  This  narrowing  of 


EXERCISE.  73 

the  chest  reduces  space  for  the  lungs,  and  interferes 
with  their  full  development.  "With  small  or  imper- 
fectly developed  lungs  the  working  of  the  whole  or- 
ganism is  affected,  for  it  is  through  the  lungs  that 
oxygen,  which  is  so  necessary  for  the  proper  trans- 
formation of  food  into  nutriment,  finds  entrance, 
and  here  also  that  a  large  portion  of  the  waste 
material  is  thrown  off.  It  is  impossible,  therefore, 
to  enjoy  perfect  health  while  so  important  an  organ 
is  compressed.  One  is  more  apt  to  fall  a  victim  to 
phthisis  and  acute  pulmonary  diseases  when  the 
lungs  are  cramped. 

During  the  period  of  youth  very  much  can  be 
done  to  guard  against  a  contracted  chest,  by  the 
daily  exercise  of  the  arms,  avoiding  a  stooping 
posture  while  sitting  or  walking,  and  by  wearing 
loose  and  easy  clothing,  so  that  there  can  be  no 
compression  of  the  chest-walls. 

Light  calisthenics,  now  practiced  in  many  Kin- 
dergarten schools,  are  an  invaluable  aid  in  assisting 
the  development  of  the  chest.  If  the  same  plan  of 
combining  physical  and  mental  training  could  be 
carried  on  throughout  the  whole  school-life  it  would 
be  productive  of  an  incalculable  amount  of  good  for 
many  children,  especially  those  who  are  delicate  and 
those  of  a  more  studious  turn  of  mind,  who  obtain 


Y4:  HYGIENE  OF  CHILDHOOD. 

very  little  exercise  except  that  received  in  walking 
to  and  from  school. 

All  games  calling  for  the  use  of  the  arms  should 
be  encouraged.  The  hoop,  battledore  and  shuttle- 
cock, bean-bags,  ball-playing  for  boys,  and  the  par- 
allel bar  for  older  children,  all  tend  to  develop  the 
chest,  and  can  be  used  during  the  winter  as  well  as 
the  summer.  The  use  of  the  skipping-rope,  in 
moderation,  may  be  permitted  for  little  girls,  but 
should  be  forbidden  as  they  approach  the  years  of 
puberty.  During  the  summer  months,  lawn  tennis 
affords  admirable  exercise,  and  is  most  beneficial  for 
girls.  It  calls  them  out  into  the  fresh  air,  brings 
into  play  all  the  muscles  of  the  arms,  loins,  and  legs, 
and  develops  the  chest.  The  game  has  sometimes 
been  condemned  for  girls — unjustly  so,  it  seems  to 
me.  Because  some  few,  who  have  more  spirit  than 
common  sense  and  physical  strength,  have  played 
to  excess  and  thereby  injured  themselves,  the  game 
should  not  be  condemned,  any  more  than  riding  or 
any  other  exercise.  When  played  in  moderation, 
under  certain  restrictions,  it  is  most  valuable  as  an 
aid  to  muscular  development.  All  clothing  worn 
while  playing  this  game  should  be  light  and  loose, 
especially  the  corsets,  which  should  have  few  bones, 
and  should  yield  readily  to  any  movement  of  the 


EXERCISE.  75 

body.  The  game  should  never  be  played  at  any 
time  during  the  period  of  menstruation.  My  expe- 
rience has  shown  that,  when  any  harmful  results 
have  followed  from  the  game,  there  have  been  in- 
dications of  previous  pelvic  irritation,  or  the  game 
has  been  played  during  menstruation,  or  while  wear- 
ing tight  corsets,  or  while  the  health  has  been  poor. 
Certainly,  the  benefits  derived  from  the  game  coun- 
terbalance a  hundred-fold  the  harm. 

With  children  who  are  delicate  by  inheritance, 
special  attention  should  be  paid  to  the  development 
of  the  chest.  Their  muscular  tissues  being  feeble 
and  the  bony  framework  abnormally  soft,  there  is 
great  danger  that  the  chest-walls  may  be  bent  for- 
ward, causing  a  compression  of  the  thoracic  cavity. 
These  children  should  be  encouraged  in  the  exercise 
of  all  the  youthful  sports,  care  being  taken  naturally 
that  they  do  not  overtax  their  strength.  In  running 
and  playing  the  lungs  are  more  fully  inflated,  thus 
helping  to  increase  their  size.  A  greater  quantity  of 
the  oxygen  of  the  air  enters  the  circulation,  and  a 
larger  amount  of  waste  matter  is  thrown  off. 

The  dainty  little  creature  who  is  praised  for  act- 
ing "  like  a  little  gentleman  "  or  "  a  little  lady,"  who 
is  reproved  for  a  particle  of  dirt  on  its  clothing,  and 
compelled  to  walk  demurely,  taking  hold  cf  the  at- 


76  HYGIENE  OF  CHILDHOOD. 

tendant's  hand,  is  generally  a  subject  for  rhubarb 
and  soda,  calomel,  ipecac,  iron,  and  other  drugs 
whose  use  becomes  necessary  to  keep  the  liver, 
lungs,  and  bowels  in  good  condition,  thus  supplant- 
ing Nature's  medicine,  exercise,  by  the  concoctions 
of  the  apothecary. 

An  inactive,  indoor  life  for  the  young  lowers  the 
vitality,  retards  the  full  development  of  the  muscles, 
induces  a  softness  and  delicacy  of  all  the  tissues, 
and  lessens  the  power  of  resisting  cold  and  diseases 
of  all  kinds. 

Housing  children  during  the  winter  weather,  as 
a  precaution  against  their  taking  cold,  is  a  very 
great  mistake.  Yery  few  colds  are  contracted  in  the 
open  air,  if  the  feet,  limbs,  and  body  are  sufficiently 
protected  in  the  manner  already  indicated,  and  if 
the  children  are  permitted  to  follow  out  their  own 
inclinations  of  running,  skipping,  and  having  free 
motion  of  the  arms,  and  are  not  exposed  for  too  long 
a  time  to  the  cold.  "When,  however,  they  are  com- 
pelled to  walk  like  "  little  gentlemen  and  ladies," 
even  when  bundled  in  furs,  the  body  soon  becomes 
chilled  if  the  weather  is  very  cold,  and  some  disturb- 
ance of  the  system  follows.  Children  should  be  ac- 
customed to  daily  exercise  in  the  open  air  in  all 
weathers,  unless,  of  course,  it  is  very  stormy  or  the 


EXERCISE.  77 

cold  is  severe,  and  even  when  delicate  they  should 
not  be  deprived  of  the  tonic  effect  of  outdoor  air, 
and  of  strengthening  the  muscles  by  exercise  in  it. 
The  first  effect  of  cold  air  upon  the  system  is  a  tonic, 
as  may  be  seen  by  the  bright  color  on  the  cheeks, 
and  a  feeling  of  exhilaration  after  a  walk  on  a  crisp 
day  in  autumn.  Prolonged  exposure  to  cold,  on  the 
other  hand,  is  very  depressing ;  delicate  children, 
therefore,  should  not  remain  too  long  out-of-doors  if 
the  weather  is  severe,  or  if  it  is  very  windy  ;  for  high 
winds,  if  cool,  rapidly  abstract  the  animal  heat,  and 
are  also  depressing.  If  a  child  is  chilled  or  cold,  it 
should  instantly  be  brought  into  the  house  to  be 
warmed  and  sent  out  again,  taking  the  fresh  air  and 
outdoor  exercise  in  installments,  as  it  were,  instead 
of  all  at  once.  Never  permit  a  child  to  remain  out- 
of-doors  when  crying  from  cold. 

Children  will  frequently  complain  of  pain  in  the 
legs  and  arms,  which  prevents  them  from  exercising 
sufficiently.  Their  parents  are  often  at  a  loss  to  de- 
termine the  extent  and  true  character  of  the  pain, 
its  transient  nature  deceiving  and  often  leading 
them  to  doubt  its  existence,  thereby  causing  much 
unnecessary  suffering,  owing  to  a  misconception  of 
the  cause ;  and,  when  the  pain  is  admitted,  it  is 
looked  upon  as  a  necessary  accompaniment  of  child- 


78  HYGIENE  OF  CHILDHOOD. 

hood.  These  so-called  "  growing  pains  " — a  mis- 
nomer— are  caused  either  by  fatigue  of  the  mus- 
cles— the  result  of  over-exertion — or  by  some  strain 
upon  the  tender  articular  surfaces,  or  are  brought 
about  by  cold,  inducing  a  species  of  muscular  rheu- 
matism. Children  of  sedentary  habits,  who  are  not 
protected  sufficiently  by  flannels,  and  also  those  of 
delicate  organization  possessing  more  energy  than 
vigor,  are  the  chief  sufferers  from  these  pains.  In 
every  case,  however,  these  pains  can  and  should  be 
promptly  relieved,  in  the  one  instance  by  warmer 
clothing,  in  the  other  by  carefully  guarding  against 
too  violent  and  prolonged  exercise. 

The  brightest  and  sunniest  room  in  the  house 
should  be  given  to  the  children  for  their  play-room ; 
this  is  especially  necessary  during  the  winter 
months,  when  they  can  not  spend  many  hours  out- 
of-doors.  Sunlight  is  as  essential  to  the  health  of 
children  as  it  is  to  plants.  One  who  has  attempted 
to  grow  plants  in  the  house  in  winter  full  well 
knows  the  importance  of  placing  them  where  the 
sun  can  shine  upon  them.  Children  living  in  sun- 
less rooms  are  not  only  injured  physically,  but 
are  apt  to  become  fretful  and  irritable,  while 
sunlight  generally  brings  brightness  and  content- 
ment. 


EXERCISE.  79 

I  wish  here  to  protest  against  that  pernicious 
habit  of  attempting  to  "  toughen  "  a  child  by  means 
of  light  clothing,  by  cold  sleeping-rooms  in  winter, 
bathing  in  too  cold  water,  and  other  harmful  pro- 
cesses, that  mistaken  mothers  adopt  in  the  harden- 
ing of  their  children.  Do  not  be  guided  by  enthu- 
siasts on  the  subject  of  cold,  but  profit  by  the  ad- 
vice of  physicians,  whose  study  and  experience  en- 
able them  to  give  proper  advice  in  this  matter. 
The  only  way  to  harden  a  child — by  which  is  meant 
rendering  him  less  susceptible  to  the  effect  of  cold, 
and  giving  him  strength  and  vigor  of  body — is  by 
rigid  adherence  to  the  laws  of  health ;  that  is,  pro- 
viding a  sufficient  amount  of  clothing,  plenty  of 
outdoor  exercise,  pure  air  to  breathe,  simple  and 
good  food,  with  ample  amount  of  sleep.  I  have  in 
mind  two  school  companions,  who  were  naturally 
delicate,  and  wished  to  harden  themselves,  that  they 
might  do  as  other  boys.  The  result  of  their  harden- 
ing, which  consisted  in  discarding  overcoats,  sleeping 
with  windows  wide  open  in  winter,  and  other  fool- 
ish habits,  was  that  they  died  from  consumption  in 
early  manhood.  This  is  the  fate  that  befalls  many. 
Do  not  suppose  that  all  children  can  be  brought  up 
under  the  same  rules.  Judgment  and  common 
sense  must  be  brought  to  bear  in  deciding  upon 


80  HYGIENE  OF  CHILDHOOD. 

questions  of  dress   and  of  exercise  in  individual 
cases.     Cast-iron  rules  will  not  apply. 

SLEEP. 

Dr.  Hammond,  in  his  valuable  treatise  on  "  Sleep 
and  its  Derangements,"  says :  "  The  state  of  gen- 
eral repose  which  accompanies  sleep  is  of  especial 
value  to  the  organism  in  allowing  the  nutrition  of 
the  nervous  tissues  to  go  on  at  a  greater  rate  than 
its  destructive  metamorphosis.  The  same  effect  is, 
of  course,  produced  upon  the  other  structures  of 
the  body,  but,  as  regards  them,  this  is  not  of  so 
much  importance,  for  while  we  are  awake  they  all 
obtain  a  not  inconsiderable  amount  of  rest.  Even 
those  actions  which  are  most  continuous,  such  as 
respiration  and  pulsation  of  the  heart,  have  distinct 
periods  of  suspension.  Thus,  after  the  contraction 
and  dilation  of  the  auricles  and  ventricles  of  the 
heart,  there  is  an  interval  during  which  the  organ 
is  at  rest.  This  amounts  to  one  fourth  of  the  time 
requisite  to  make  one  pulsation  and  begin  another. 
During  six  hours  of  the  twenty-four  the  heart  is? 
therefore,  in  a  state  of  complete  repose.  If  we  di- 
vide the  respiratory  act  into  three  equal  parts,  one 
will  be  occupied  in  inspiration,  one  in  expiration, 
and  the  other  by  a  period  of  quiescence.  During 


SLEEP.  81 

eight  hours  of  the  day,  therefore,  the  muscles  of 
respiration  and  the  lungs  are  inactive.  And  so 
with  the  several  glands.  Each  has  its  time  for  rest. 
And  of  the  voluntary  muscles,  none — even  during 
our  most  untiring  waking  moments — are  kept  in 
continued  action.  .  .  . 

"  But  for  the  brain  there  is  no  rest  except  dur- 
ing sleep.  So  Jong  as  an  individual  is  awake,  there 
is  not  a  single  second  of  his  life  during  which  his 
brain  is  altogether  inactive.  ...  Its  substance  is 
consumed  by  every  thought,  by  every  action  of  the 
will,  by  every  sound  that  is  heard,  by  every  object 
that  is  seen,  by  every  substance  that  is  touched,  by 
every  odor  that  is  smelled,  by  every  painful  or 
pleasurable  sensation ;  and  so  each  instant  of  our 
lives  witnesses  the  decay  of  some  portion  of  its 
mass,  and  the  formation  of  new  material  to  take  its 
plac3.  .  .  . 

"  The  necessity  for  sleep  is  due  to  the  fact  that 
during  our  waking  moments  the  formation  of  the 
new  substance  does  not  go  on  as  rapidly  as  the  decay 
of  the  old.  The  state  of  comparative  repose  which 
attends  upon  this  condition  allows  the  balance  to 
be  restored,  and  hence  the  feeling  of  freshness 
and  rejuvenation  we  experience  after  a  sound  and 
healthy  sleep." 


82  HYGIENE  OF  CHILDHOOD. 

The  necessity  of  sleep  during  childhood  is  vastly 
greater  than  during  adult  life,  for  during  the  former 
period  there  is  a  proportionately  greater  destruction 
of  nerve-tissue,  as  the  result  of  the  ceaseless  activity 
of  the  child  ;  and  longer  duration  of  sleep  is  requi- 
site, to  allow  time  for  the  reparation  of  the  substance 
destroyed,  and  the  addition  of  new  matter  for  the 
growth  and  development  of  the  brain  and  nervous 
organization.  The  child  of  six  or  seven  years  of 
age  requires  at  least  eleven  or  twelve  hours  night 
sleep,  and  should  be  in  bed  by  half-past  6  or  7  P.  M. 
The  duration  of  sleep  after  the  seventh  year  may 
be  gradually  diminished  up  to  the  period  of  puberty, 
when  nine  or  ten  hours  will  be  sufficient.  A  nap 
in  the  middle  of  the  day  is  desirable  for  all  young 
children,  and  quite  important  for  a  child  under  four 
years  of  age.  It  gives  the  nervous  system  a  rest, 
and  makes  a  break  in  the  nerve  excitability  that 
always  exists  at  an  early  age.  If  the  noon  nap  is 
not  prolonged  over  an  hour  or  an  hour  and  a  half,  it 
will  rarely  have  any  effect  upon  the  duration  of  the 
night  sleep ;  on  the  contrary,  it  will  frequently  be  the 
means  of  aiding  good  sleep  at  this  time,  by  checking 
that  excitability  of  the  brain  which  so  often  prevents 
children  from  quickly  falling  asleep  after  retiring. 

The  symptoms  resulting  from  too  little  sleep  are 


SLEEP.  83 

nervous  irritability,  restlessness,  loss  of  flesh,  and  a 
delicacy  of  digestion.  Many  will  exhibit  a  dull- 
ness, pallor  of  the  face,  and  a  disinclination  to  play. 
When  from  any  circumstances  a  child  has  acquired 
the  habit  of  lying  awake  for  a  long  time  after  going 
to  bed,  a  full  warm  bath,  or  even  a  warm  foot-bath, 
given  just  before  retiring,  will  be  of  benefit.  The 
suggestions  to  be  mentioned  hereafter  regarding  the 
avoidance  of  mental  work  or  excitement  after  sup- 
per, all  of  which  will  prevent  undue  brain  activity, 
and  soon  restore  the  habit  of  quiet,  restful  sleep, 
should  also  be  noted. 

In  the  era  in  which  we  live,  the  necessity  of 
plenty  of  sleep  for  the  youthful  brain  is  of  vital 
importance.  The  parents  of  many  of  the  present 
generation  of  children  are  of  an  exceedingly  nervous 
temperament,  and  we  naturally  look  for  a  highly 
wrought  nervous  organization  in  their  offspring. 
For  this  class  especially,  and  for  those  in  whose 
family  there  is  consumption,  or  a  tendency  toward 
delicacy  of  the  body,  it  becomes  a  matter  of  the 
highest  importance  that  the  child  should  have  an 
ample  amount  of  sleep  ;  when  this  requirement  is 
not  fulfilled,  there  is  far  greater  likelihood  of  the 
development  of  the  hereditary  disease,  while  there 
is  less  resistance  to  illness  of  all  kinds. 


84  HYGIENE  OF  CHILDHOOD. 

Abundance  of  sleep  is  very  essential  during  the 
maturing  years,  to  enable  the  nervous  system  to 
acquire  firmness  and  vigor.  Insufficient  amount  of 
sleep  often  results  in  smallness  of  stature  or  stunted 
growth,  and  in  insanity  in  later  years.  I  have  said 
that  the  nerve  system  needs  a  certain  amount  of 
rest,  in  order  to  direct  the  building  up  and  the 
repairing  of  wastes.  If  this  full  amount  of  rest  is 
not  obtained,  the  building-up  process  is  likely  to  be 
interfered  with,  or,  if  the  nerve-force  is  successful 
in  both  building  up  and  repairing  the  wastes,  it  is 
apt  to  suffer  a  collapse  in  after-years,  like  the  boiler 
in  a  factory,  that  may  be  of  service  for  many  years, 
under  a  reasonable  amount  of  work,  but  which,  when 
run  under  high  pressure,  with  roaring  fires,  very 
soon  gives  out,  and  explosion  ensues. 

The  hour  immediately  preceding  bedtime  should 
be  spent  quietly,  in  order  to  relieve  the  nervous  sys- 
tem from  all  excitement.  Romping  and  excited  play 
that  young  children  frequently  indulge  in,  and  the 
exciting  tales  of  fiction  that  older  children  pore  over 
just  before  the  hour  of  bedtime,  are  very  detrimental 
and  should  never  be  permitted.  They  stimulate  the 
circulation  of  the  brain,  and  very  frequently  cause 
dreams,  "  night  terrors,"  restlessness,  disturbed  and 
insufficient  sleep.  Children  may  amuse  themselves 


SLEEP.  85 

with  light  games,  knitting,  and  crochet,  or  they 
may  be  read  aloud  to,  provided  the  book  is  not 
exciting,  but  anything  bordering  on  excitement  or 
brain-work  should  be  avoided.  With  the  dreamer, 
the  nervous  system  does  not  obtain  its  proper  rest, 
though  the  body  is  asleep,  for  there  is  as  much 
expenditure  of  nerve-force  during  the  moments 
or  hours  of  dreaming  as  there  would  be  if  the 
child  were  awake  and  undergoing  the  same  mental 
thoughts  and  excitement.  Therefore,  it  is  of  the 
greatest  importance,  in  order  that  the  full  nerve- 
rest  may  be  obtained  during  the  sleeping  hours, 
so  to  conduct  the  child's  general  hygiene  that  the 
dreams  do  not  occur.  Frightening  stories  told  by 
nurses,  with  the  idea  of  enforcing  obedience,  are 
frequently  the  direct  cause  of  the  night's  terrors 
and  dreams  of  childhood. 

I  have  already  reminded  the  reader  of  the  fact 
that  one  half  to  one  third  of  a  child's  life  is  spent  in 
bed,  and  have  incidentally  alluded  to  the  great  im- 
portance of  the  individual  surroundings  during  this 
period.  It  is  perhaps  wise,  in  considering  this  sec- 
tion, to  give  a  resume  of  the  conditions  favorable  to 
a  healthy  sleep.  These  may  be  briefly  stated  as  fol- 
lows :  The  bedroom  should  be  well  ventilated,  in 
order  to  maintain  pure  air,  which  should  not  be 


86  HYGIENE  OF  CHILDHOOD. 

overheated  or  too  cold;  the  personal  clothing  should 
be  loose  and  free,  to  permit  good  circulation;  the 
bed-covering  should  not  be  too  warm  nor  too  heavy, 
for  heavy  covering  embarrasses  respiration  and  cre- 
ates restlessness  ;  the  sleeper  should  breathe  through 
the  nose,  and  keep  the  mouth  shut;  indigestible 
food  should  be  avoided  late  in  the  day ;  those  who 
are  not  strong  will  sleep  better  by  taking  some  light, 
digestible  food  just  at  bedtime  ;  there  should  be  an 
avoidance  of  mental  excitement  or  activity  during 
the  hour  preceding  that  of  retiring. 

REGULARITY  OF  THE  BOWELS. 

The  removal  from  the  system  of  used-up  or 
waste  material  is  accomplished  through  four  chan- 
nels, viz.,  the  lungs,  the  skin,  the  bowels,  and  the 
kidneys ;  and  for  the  preservation  of  health  it  is ' 
of  the  highest  importance  that  all  these  means  of 
exit  should  be  kept  in  perfect  condition.  If  any 
one  of  these  excretory  organs  fails  to  do  its  share 
of  elimination,  its  duty  must  fall  upon  the  others, 
in  which  case  they  are  overtaxed,  and  in  turn  are 
disturbed  in  their  functions.  At  the  same  time  the 
noxious  matter,  which  should  pass  out,  is  retained 
in  the  system  too  long,  producing  self-poisoning. 


REGULARITY  OF  THE  BOWELS.  87 

The  elimination  from  the  lungs  and  kidneys 
generally  takes  place  in  a  healthy  manner  during 
childhood ;  on  the  other  hand,  there  is  a  liability  to 
imperfect  performance  of  the  duty  required  of  the 
bowels  and  skin,  and  of  fostering  a  chronic,  morbid 
condition  of  these  channels  of  elimination.  Many 
parents  and  nurses  are  not  aware  of  the  misery  and 
discomfort,  to  say  nothing  of  ill  health,  that  they 
are  responsible  for,  by  neglecting  to  impress  upon 
the  child  the  extreme  necessity  of  a  daily  action 
from  the  bowels.  The  statement  of  a  young  child 
should  not  be  relied  upon,  but  it  should  be  the  duty 
of  the  mother  or  nurse  to  see  that  the  act  is  daily 
accomplished.  The  child,  having  grown  older  and 
having  reached  the  period  of  school-life,  is  very  apt 
to  hasten  out  to  play  or  to  school,  and  to  neglect 
the  call  of  Nature.  If  Nature's  calls  are  frequently 
neglected,  she  will  after  a  while  cease  to  convey  to 
the  brain  the  impression  that  the  bowels  should  be 
evacuated,  and  we  are  then  forced  to  give  a  stimu- 
lant or  excitant,  in  the  form  of  medicine,  to  insure 
an  action. 

Aside  from  the  neglect  above  mentioned,  the 
causes  which  bring  about  constipation  are,  either 
insufficient  amount  of  vegetable  and  coarse  farina- 
ceous food,  a  defective  nerve-force,  or  general  phys- 


88  HYGIENE  OF  CHILDHOOD. 

ical  weakness,  with  deficiency  of  intestinal  secretion, 
want  of  daily  exercise,  or  intestinal  catarrh.  In  the 
effort  to  establish  regularity,  the  immediate  cause  of 
the  constipation  should  be  ascertained,  and  the  de- 
fect remedied,  in  preference  to  placing  dependence 
on  medicine.  Reliance  upon  medicines  or  injec- 
tions should  be  carefully  guarded  against,  for,  if 
the  habit  be  once  formed,  there  is  great  likelihood 
of  its  being  continued  throughout  life.  Constipa- 
tion with  young  children  is  often  due  to  a  mild 
intestinal  catarrh,  which  is  induced  by  the  impres- 
sion of  cold  upon  the  surface  of  the  body  conse- 
quent upon  scanty  clothing  and  bare  legs.  The  slimy 
mucus  which  is  excreted  in  this  catarrhal  state 
covers  the  feculent  material  and  thereby  diminishes 
the  natural  stimulation  of  the  peristaltic  action,  and 
favors  an  accumulation  of  the  faeces.  The  remedy 
for  constipation  from  this  cause  is  to  be  found  in 
extra  warmth  and  protection  to  the  body. 

Neglect  in  establishing  regular  daily  action  of 
the  bowels  leads  to  great  discomfort  in  after-life ; 
aside  from  this,  there  is  a  vitiation  of  the  system,  a 
self-poisoning,  an  absorption  into  the  blood  of  the 
gases  and  other  obnoxious  matters.  Headache,  las- 
situde, impairment  of  memory  resulting  from  poi- 
soning of  the  nervous  system,  indigestion,  muddy 


REGULARITY  OF  THE  BOWELS.  89 

complexion,  pimples,  and  bad  breath,  all  follow. 
The  child  becomes  dull  or  stupid,  and  is  then  pun- 
ished most  unjustly  for  a  mental  condition  arising 
from  the  inattention  of  others  to  his  physical  condi- 
tion. Constipation  is  a  prolific  cause  of  dyspepsia 
and  the  attendant  evils  to  which  the  child  will  be 
subjected  until  regularity  of  the  bowels  is  estab- 
lished. Not  only  should  the  habit  of  evacuating  the 
bowels  at  a  definite  time  of  the  day  be  taught,  but 
a  sufficient  time  should  be  allowed  to  permit  the 
complete  accomplishment  of  the  movement,  for, 
when  there  is  a  torpid  condition  of  the  bowels,  too 
frequently  the  child  does  not  remain  seated  long 
enough  to  force  downward  the  feculent  matter ;  and, 
becoming  impatient  at  the  delay,  he  hastens  out 
without  accomplishing  the  act,  thus  increasing  the 
constipated  habit  and  creating  a  call  for  medicine. 

The  peristaltic  action  of  the  intestine  is  stimu- 
lated by  food  containing  a  good  deal  of  cellular 
structure  or  waste  material,  such  as  rye  bread  and 
oatmeal,  also  fruit  of  an  acid  nature.  Baked  apples 
or  stewed  fruit,  also  prunes,  are  excellent  at  the  last 
meal  of  the  day.  When  fresh  ripe  fruit  can  not  be 
obtained,  an  orange  or  scraped  apple  during  the  day 
promotes  the  intestinal  secretions  and  action  from 
the  bowels,  and  can  be  given  to  the  youngest  child. 


90  HYGIENE  OF  CHILDHOOD. 

Much  benefit  is  derived  from  deep  kneading  of  the 
bowels,  especially  on  the  left  side.  In  some  instances 
it  is  necessary  to  resort  to  medicines  ;  in  such  cases 
guidance  should  be  sought  from  the  physician. 


CAEE  OF  THE  SKIN. 

I  have  already  alluded  to  the  necessity  of  pro- 
tecting the  skin  from  exposure  to  cold  or  from  a 
sudden  chill,  in  order  that  its  important  function  of 
eliminating  from  the  body  its  share  of  waste  mate- 
rial may  not  be  interfered  with.  I  have  stated  that, 
when  this  duty  is  interfered  with,  the  refuse  matter 
is  retained  in  the  system  longer  than  necessary, 
a  self-poisoning  is  produced,  and,  in  passing  out 
through  the  other  channels  of  elimination,  the 
lungs,  the  bowels,  and  the  kidneys,  these  organs  be- 
come overtaxed  and  irritated,  causing  a  predisposi- 
tion to  disease.  It  is  evidently,  therefore,  of  the 
highest  importance  that  the  skin  should  be  kept  in 
as  perfect  a  condition  of  health  as  possible.  To 
this  end  two  conditions  must  be  fulfilled :  its  cir- 
culation must  be  maintained  in  an  active  condition 
by  sufficient  clothing,  and  the  unwholesome  mate- 
rial which  is  constantly  thrown  out,  through  millions 
of  glands  in  the  skin,  must  be  removed  by  frequent 


CARE  OF  THE  SKIN.  91 

bathing  and  friction.  The  danger  was  startlingly 
demonstrated  of  interfering  with  the  eliminative 
function  of  the  skin,  and  a  signal  proof  of  the  im- 
portant part  which  it  plays  in  the  maintenance  of 
health  was  afforded,  in  the  well-known  instance  of 
the  "  gilded  boy,"  at  one  of  the  carnivals  in  Flor- 
ence during  the  fifteenth  century.  The  unfortu- 
nate child,  in  order  to  represent  the  dawn  of  the 
golden  age,  was  covered  from  head  to  foot  with 
gold  foil.  This  covering  completely  closed  the 
openings  of  the  excretory  glands  of  the  skin,  and 
caused  a  retention  of  the  refuse  matter  which 
should  have  passed  out.  The  result  was  the  child's 
death  within  two  days. 

When  the  skin  is  rendered  inactive,  through  in- 
sufficient covering,  an  injurious  effect  upon  the 
system  follows,  differing  only  in  degree,  as  in  the 
case  of  the  "  gilded  boy."  As  the  life  of  the  gilded 
boy  was  sacrificed  to  the  desire  for  show,  so  many 
mothers,  through  their  desire  to  beautify  their 
infants  and  children,  by  dressing  them  in  short 
socks,  with  arms  thinly  covered,  and  often  without 
flannels,  are  as  surely  impairing  their  health,  if  not 
actually  and  slowly  putting  their  offspring  to  death 
by  a  fatal  disregard  of  the  law  of  health  that  re- 
quires full  activity  of  the  glands  of  the  skin. 


92  HYGIENE  OF  CHILDHOOD. 

Stereotyped  rules  of  guiding  the  life  of  a  child 
from  infancy  to  maturity  cause  many  a  little  one  to 
fall  by  the  wayside.  While  certain  fixed  principles 
for  guidance  may  be  established,  the  minutiae  must 
vary  according  to  age,  temperament,  and  vigor  of 
health.  This  statement  applies  with  especial  force 
to  the  bath.  Judgment  and  common  sense  must  be 
exercised  in  this  apparently  simple  duty,  for  one 
child  may  be  benefited  by  a  method  of  bathing  that 
would  exert  a  positively  injurious  effect  upon  an- 
other. 

Among  the  ignorant,  filth  of  person  is  as  com- 
mon as  the  filth  of  their  habitations,  and  ability  to 
bring  about  reform  in  either  case  is  almost  a  hope- 
less task  On  the  other  hand,  among  the  intelli- 
gent, the  neglect  of  free  ablution  is  not  great ;  but 
there  is  danger,  however,  in  its  abuse.  Like  all 
good  things  the  bath  is  often  a  powerful  agent  for 
evil  as  well  as  for  good.  Unless  used  intelligently, 
both  warm  and  cold  baths  may  exert  a  beneficial  or 
detrimental  effect  upon  the  system,  according  to  the 
method  and  frequency  of  giving  them,  and  the  con- 
dition of  the  child. 

The  warm  bath  benefits  by  directly  stimulating 
the  cutaneous  circulation,  and  increasing  the  activity 
of  the  perspiratory  glands.  Calling  the  circulation 


CASE  OF  THE  SKIN.  93 

to  the  surface  necessarily  diminishes  the  supply 
to  the  internal  organs,  and  consequently  affects  the 
activity  of  their  secretions.  If  too  long  a  time  is 
occupied  in  giving  the  bath,  or  it  is  too  frequent, 
general  lassitude  is  very  apt  to  ensue. 

The  immediate  effect  of  cold  water  upon  the 
skin  is  to  drive  the  circulation  to  the  inner  organs 
of  the  body ;  then,  by  its  impression  upon  the  nerve- 
centers,  there  takes  place  the  excitement  of  reaction, 
which  soon  restores  the  superficial  circulation  in 
redoubled  force,  as  is  shown  by  the  ruddy  appear- 
ance and  glow  of  the  surface.  If  the  circulation  is 
sluggish,  the  nervous  force  weak,  or  the  power  of 
reaction  feeble,  then  the  cold  to  the  surface  has 
a  contrary  effect,  and  does  an  immense  amount  of 
evil,  for  the  internal  organs  remain  congested,  and 
there  results  an  impairment  of  their  functions.  If 
after  a  cold  bath  the  skin  remains  pallid,  the  lingers 
blue  and  cold,  it  indicates  that  the  reaction  is  incom- 
plete, and  that  the  effects  are  injurious ;  or  if,  after 
reaction  has  taken  place,  there  follow  sensations  of 
languor,  headache,  chilliness,  or  general  weariness,  it 
indicates  that  the  cold  bath  is  doing  a  positive  harm 
and  is  too  depressing ;  in  both  of  these  cases  bath- 
ing in  tepid  water  should  be  substituted. 

During  the  winter  months  a  bath  two  or  three 


94  HYGIENE  OF  CHILDHOOD. 

times  a  week  will  be  sufficient  for  a  child  from  the 
age  of  three  to  ten  years.  The  temperature  of  the 
water  should  be  from  90°  to  95°  Fahr.,  and  the  bath 
should  be  given  at  night.  Boys  and  girls  of  older 
years,  who  have  robust  constitutions  and  full,  active 
circulation,  may  with  benefit  indulge  in  a  daily 
sponging  with  cool  water  (temperature  70°  to  75° 
Fahr.),  provided  it  is  always  done  in  a  warm  room ; 
but  a  child  under  ten  years  of  age,  or  one  who  has 
heart  or  pulmonary  trouble,  whose  circulation  is 
feeble,  or  one  who  is  of  nervous  temperament,  or 
who  is  not  in  a  robust  condition  of  health,  should 
never  be  permitted  to  enter  a  bath  during  the  win- 
ter in  water  under  90°  Fahr.  or  to  be  sponged  oif  in 
very  cold  water. 

Children  who  enjoy  and  are  benefited  by  their 
daily  morning  sponge-baths  during  the  summer  can 
not  always  carry  it  on  with  impunity  during  the 
autumn  and  winter ;  for  the  vitality  of  many  is  so 
poor  during  the  early  hours  of  the  day,  that  the 
sponge-bath,  even  with  tepid  water,  at  this  time 
exerts  such  an  enervating  effect  that  the  functions 
of  digestion  are  partially  arrested,  the  appetite  for 
breakfast  is  apt  to  be  blunted,  and  a  lassitude  which 
is  attributed  to  other  causes  is  induced.  Daily 
sponging  the  feet  with  cold  water,  when  followed 


CARE  OF  THE  SKIN.  95 

by  brisk  friction  with  a  to  we],  can  be  borne  by  all 
children  during  the  winter  months,  and  is  especially 
beneficial  when  they  complain  of  cold  feet ;  spong- 
ing the  throat  and  shoulders  with  cool  water  will 
also  be  beneficial  and  instrumental  in  warding  off 
throat  colds. 

During  the  summer  months,  on  account  of  the 
increased  activity  of  the  cutaneous  glands,  a  very 
much  larger  amount  of  deleterious  matter  is  elimi- 
nated from  the  skin  than  during  colder  weather; 
the  bath  at  this  period  becomes,  therefore,  a  greater 
necessity.  A  daily  sponge  or  full  bath  is  not  only 
productive  of  increased  healthfulness,  but  is  refresh- 
ing and  adds  to  the  comfort  of  the  body. 

In  giving  a  sponge-bath,  the  child  should  stand 
or  sit  in  a  tub,  in  which  there  is  perhaps  two  or 
three  inches  of  water,  and  be  rapidly  sponged ;  this 
should  be  supplemented  by  moderately  vigorous 
friction  with  a  coarse  towel  until  the  skin  is  in  a 
glow. 

I  have  frequently  seen  a  rapid  improvement  in 
the  health  of  a  child  by  simply  substituting  a  bath 
once  a  week  for  an  accustomed  daily  bath,  and  order- 
ing the  entire  body  to  be  vigorously  rubbed  with  a 
coarse  towel  night  and  morning.  The  skin  of  many 
children,  especially  those  who  do  not  take  much  ex- 


96  HYGIENE  OF  CHILDHOOD. 

ercise,  is  so  inactive  during  the  winter  months,  that 
it  fails  to  exercise  its  accustomed  duty  of  elimina- 
tion. 

In  such  cases,  vigorous  rubbing  stimulates  the  cir- 
culation, thereby  increases  the  activity  of  the  sweat- 
glands  and  opens  their  ducts,  causing  far  greater 
benefit  than  the  daily  sponging  or  bath.  Rubbing 
the  body  rapidly  with  a  coarse  towel,  that  has  been 
wet  and  wrung  as  dry  as  possible,  is  an  admirable 
substitute,  during  cold  weather,  for  the  daily  sponge- 
bath  for  children  whose  circulation  is  defective ;  the 
necessary  cleanliness  is  secured,  and  a  delightful 
glow  and  a  feeling  of  warmth  are  experienced. 

Salt  water  for  bathing  or  sponging  is  extremely 
beneficial  when  the  circulation  is  defective,  and  may 
be  used  two  or  three  times  a  week  with  great  advan- 
tage by  children  who  perspire  too  freely,  owing  to 
weakness.  The  salt  in  the  water  is  a  stimulant  to 
the  relaxed  cutaneous  blood-vessels,  and  exerts  a 
tonic  effect  upon  the  whole  system.  It  is  not  neces- 
sary to  go  to  the  sea-shore  to  obtain  the  salt  water, 
for  it  can  be  made  in  any  household  by  mixing 
coarse  salt  or  Ditman's  sea  salt  with  ordinary  water. 
During  the  summer  months,  the  health  of  many 
drooping  children  can  be  restored  by  the  use  of 
these  tepid  or  cool  "  home  sea-baths." 


CARE  OF  THE  SKItf.  97 

Early  youth  is  not  the  period  to  attempt  a  hard- 
ening process.  A  protest  has  already  been  entered 
against  the  hardening  by  scanty  clothing,  and  now 
my  protest  is  offered  against  hardening  by  cold 
baths.  Some  children  will  come  through  the  pro- 
cess successfully,  and  be  held  up  as  examples  of  the 
benefits  of  cold  water,  but  the  many  unsuccessful, 
who  will  fall  under  the  observation  of  the  physician, 
are  lost  sight  of. 

In  the  effort  to  avoid  too  cold  baths,  care  must 
be  taken  that  an  error  is  not  made  of  giving  too  hot 
baths,  for  it  must  be  remembered  that  hot  baths  are 
as  depressing  as  the  cold  baths  are  exhausting. 

The  duration  of  the  bath  is  also  an  important 
matter  of  consideration.  A  bath  in  cool  water  should 
never  occupy  longer  than  five  minutes,  and  a  full 
warm  bath  longer  than  ten  minutes.  If  the  child  is 
permitted  to  remain  longer  in  the  water,  more  or  less 
exhaustion  will  follow,  which,  if  repeated  daily,  or 
several  times  a  week,  will  result  in  an  enfeebled  con- 
dition of  body.  The  bath  in  the  ocean  can  often 
be  extended  to  fifteen  or  twenty  minutes  if  the  surf 
is  not  too  high.  While  bathing  in  the  ocean,  the 
activity  of  the  body  and  the  splash  of  the  water 
stimulate  the  circulation  and  prevent  the  depres- 
sion that  would  otherwise  take  place.  The  ocean 


98  HYGIENE  OF  CHILDHOOD. 

bath,  while  capable  of  restoring  vigor  and  health  to 
those  who  make  proper  use  of  it,  is  also  a  powerful 
agent  for  evil.  The  tonic  effect  of  sea  air  and  active 
country  life,  is  too  often  done  away  with  by  the 
prolonged  arid  too  frequent  sea-bathing.  I  could 
detail  numerous  cases  of  prostration  directly  induced 
by  too  free  indulgence  in  the  ocean  bath ;  in  some 
cases  it  has  taken  months  to  restore  the  health  that 
has  been  impaired  by  the  ocean  baths.  A  child 
under  fourteen  should  not  be  permitted  to  bathe  in 
the  ocean  daily,  nor  should  it  be  allowed  to  bathe 
when  the  temperature  of  the  sea- water  is  under  70° 
Fahr. 

Wading  or  paddling  in  the  sea-water  is  not 
always  devoid  of  danger.  Children  are  frequently 
permitted  this  indulgence  before  the  water  is  warm 
enough  for  a  full  bath,  and  as  a  consequence  of  the 
direct  heat  of  the  sun  upon  the  head  and  upper  part 
of  the  body,  and  of  the  cold  water  about  the  feet  and 
legs,  there  are  often  induced  sharp  intestinal  disorder 
and  congestion  of  the  liver,  and  more  or  less  dis- 
turbance of  the  nervous  system,  evinced  by  head- 
ache and  restlessness  at  night.  With  certain  restric- 
tions, wading  in  the  sea-water  is  naturally  allowable, 
but  parents  must  be  on  their  guard  that  delicate 
children  do  not  remain  too  long  in  the  enjoyment 


CARE  OF  THE  SKIN.  99 

of  this  pleasure,  and  that  it  is  not  indulged  in  when 
the  water  is  cold. 

The  following  quaint  verses,  published  some 
time  ago  in  England,  by  Mr.  Joseph  Power,  bear  so 
practically  on  this  subject  that  they  are  here  quoted 
in  full : 

TUB  SKIN. 

There's  a  skin  without  and  a  skin  within, 

A  covering  skin  and  a  lining  skin ; 

But  the  skin  within  is  the  skin  without, 

Doubled  inward,  and  carried  completely  throughout. 

The  plate,  the  nostrils,  the  windpipe,  and  throat, 
Are  all  of  them  lined  with  this  inner  coat ; 
Which  through  every  part  is  made  to  extend — 
Lungs,  liver,  and  bowels — from  end  to  end. 

The  outside  skin  is  a  marvelous  plan 

For  excreting  the  dregs  of  man ; 

While  the  inner  extracts  from  the  food  and  the  air 

What  is  needed  the  waste  of  the  flesh  to  repair. 

Too  much  brandy,  whisky,  or  gin, 
Is  apt  to  disorder  the  skin  within; 
While  if  dirty  and  dry,  the  skin  without 
Refuses  to  let  the  sweat  come  out. 

Good  people  all,  have  a  care  of  your  skin, 
Both  that  without  and  that  within ; 
To  the  first  give  plenty  of  water  and  soap ; 
To  the  last  little  else  but  water,  we  hope.  . 

But  always  be  very  particular  where 

You  get  your  water,  your  food,  and  your  air; 


100  HYGIENE  OF  CHILDHOOD. 

For  if  these  be  tainted  or  rendered  impure, 
It  will  have  its  effect  on  the  blood,  be  sure. 

The  food  which  will  ever  for  you  be  the  best 
Is  that  you  like  most  and  can  soonest  digest ; 
All  unripe  fruit  and  decaying  flesh 
Beware  of,  and  fish  that  is  not  very  fresh. 

Your  water,  transparent  and  pure  as  you  think  it, 
Had  better  be  filtered  and  boiled  ere  you  drink  it ; 
Unless  you  know  surely  that  nothing  unsound 
Can  have  got  to  it  over  or  under  the  ground. 

But  of  all  things  the  most  I  would  have  you  beware, 
Is  breathing  the  poison  of  once-breathed  air  ; 
When  in  bed,  whether  out,  or  at  home  you  may  be, 
Always  open  the  windows  and  let  it  go  free. 

With  clothing  and  exercise  keep  yourself  warm, 
And  change  your  clothes  quickly  if  caught  in  a  storm ; 
For  a  cold  caught  by  chilling  the  outside  skin, 
Flies  at  once  to  the  delicate  lining  within. 

All  you  who  thus  kindly  take  care  of  your  skin, 
And  attend  to  its  wants  without  and  within, 
Need  never  of  cholera  feel  any  fears, 
And  your  skin  may  last  you  a  hundred  years. 


EDUCATION. 

It  is  generally  admitted  that  insanity  and  various 
diseases  of  the  nervous  system  have  materially  in- 
creased during  the  past  decade.  One  prominent 
cause  for  this  is  the  great  strain  imposed  upon  the 
nervous  system  by  the  demands  of  our  present  civili- 


EDUCATION.  101 

zation.  The  requirements  necessary  to  success  in 
life  are  now  far  greater  than  was  the  case  a  score  of 
years  ago ;  and  to  meet  this  increased  tax  requires  a 
vigorous  physique  and  a  healthy  nervous  system,  the 
foundations  of  which  must  be  laid  during  the  years 
of  growth.  It  is  important,  therefore,  that  the 
child's  development  should  be  carefully  guarded 
from  everything  that  will  detract  from  the  posses- 
sion of  "mens  sana  in  cor  pore  sano." 

The  nervous  system,  which  controls  and  directs 
the  working  of  the  whole  organism,  must  not  be 
exhausted  or  overtaxed,  for,  when  this  occurs,  all  the 
functions  of  the  body  are  more  or  less  perverted  in 
their  action,  and  the  full  strength  of  nerve-force  is 
frequently  not  regained.  A  parent's  aim  for  his 
child  during  early  youth  should  be  that  he  may 
develop  a  healthy  physique,  rather  than  that  he 
should  obtain  any  amount  of  knowledge  from  books. 
The  mental  faculties  should  be  allowed  to  develop 
slowly,  as  much  as  possible  without  stimulation,  and 
the  life  should  be  more  like  that  of  a  young  animal. 
The  early  over-stimulation  of  the  brain  diverts  the 
nerve-force  from  its  most  important  duty  of  direct- 
ing the  growth  of  the  body.  By  committing  to 
memory  too  many  nursery  rhymes  the  mind  is  over- 
taxed, and  harmful  results  are  sure  to  follow.  Young 


102  HYGIENE  OF  CHILDHOOD. 

children  are  often  made  wakeful  at  night,  have 
dreamy,  startled  sleep,  and  are  unable  to  take  the 
noonday  nap,  which  is  so  important  for  them,  simply 
because  the  brain  has  been  over- stimulated  and  excit- 
ed by  too  much  brain-work.  Among  the  educated 
classes  a  child  under  six  years  of  age  will  absorb 
ideas  as  rapidly  as  it  is  good  for  the  brain,  simply 
from  association  with  older  people.  From  the  stories 
read  aloud,  and  from  the  illustrated  blocks  and  pict- 
ure-books that  are  now  so  abundantly  supplied  to  the 
nursery  they  will  often  learn  the  alphabet  and  possi- 
bly begin  to  spell  out  a  few  words. 

The  age  at  which  a  child  should  commence 
school  duties  opens  a  subject  upon  which  there  is  a 
great  diversity  of  opinion.  The  majority  of  physi- 
cians, and  others  who  have  made  the  hygiene  of  child- 
hood a  study,  are  convinced  that  a  child  under  six,  and 
in  many  instances  under  seven  years  of  age,  should 
not  be  permitted  regular  lessons,  or  have  school  du- 
ties, and  that  from  the  age  of  seven  to  ten,  the  confine- 
ment in  the  school-room  should  never  be  longer 
than  from  three  to  three  and  a  half  hours  daily. 
Sending  the  child  to  school  "  to  be  kept  out  of  mis- 
chief "  is  a  dangerous  expedient. 

Kindergarten  instruction  is  invaluable  for  chil- 
dren between  the  ages  of  four  and  seven  years,  and 


EDUCATION.  103 

its  advantages  are  being  more  and  more  appreciated 
by  parents.  By  it,  physical  and  mental  education 
are  carried  on  side  by  side,  in  such  a  manner  that 
there  is  no  over-stimulation  of  the  nervous  system, 
the  powers  of  observation  and  reasoning  are  de- 
veloped, and  the  child  is  better  equipped  for  the 
regular  duties  of  school-life  after  the  seventh  year. 

The  attention  to  hygiene,  now  more  thoroughly 
understood,  and  the  more  intelligent  care  of  infants 
and  children,  have  lessened,  to  a  very  great  extent, 
the  mortality  of  the  young.  As  a  result,  there  now 
survives  a  very  much  larger  percentage  of  children 
who  are  delicate  by  inheritance,  than  was  the  case 
during  the  early  days  of  our  ancestors.  This 
inherited  delicacy  is  too  often  not  recognized, 
and  the  child  undergoes  the  same  mental  and  physi- 
cal regimen  as  children  of  stronger  constitution, 
instead  of  being  given  time  to  mature  more  slowly 
and  acquire  a  firmness  of  tissue  and  nerve  strength, 
before  the  strain  of  school  duties  begins.  It  fre- 
quently happens  that  children  who  are  delicate  by  in- 
heritance have  unusually  bright  minds  and  are  quick 
and  eager  to  learn.  Parents  should  be  very  guarded 
in  these  cases  to  curb  the  child's  precocity,  and 
should  direct  their  attention,  during  early  youth,  to 
strengthening  the  body,  in  order  that  at  maturity 


104  HYGIENE  OF  CHILDHOOD. 

the  physical  strength  may  permit  the  full  enjoy- 
ment of  mental  activity. 

It  should  be  carefully  looked  to  that  the  hours 
for  sleep  and  exercise,  which  I  have  already  shown 
to  be  of  great  importance,  are  not  drawn  upon  for 
study,  otherwise  physical  degeneracy  will  follow  as 
a  result.  The  excessive  demand  of  the  brain  for 
blood,  which  is  always  the  case  where  there  is  over- 
study,  deprives  the  other  parts  of  the  body  of  their 
share.  Prolonged  mental  work  induces  more  or 
less  exhaustion  of  the  nerve-force,  thus  depriving 
the  nervous  system  of  its  ability  to  fulfil  its  mission 
of  guiding  and  controlling  the  workings  of  the  vari- 
ous organs  of  the  body.  The  functions  of  digestion 
especially  suffer  from  the  faulty  nerve-force,  and 
this  induces  indigestion,  and  adds  another  cause  of 
delicacy  as  the  result  of  over-stimulation  of  mental 
powers. 

The  question  of  mental  training  for  the  young 
is  too  broad  a  subject  for  me  to  enter  upon  in  this 
compendium ;  I  merely  wish  to  utter  a  few  words 
of  warning  as  to  the  danger  of  too  early  and  forced 
instruction,  some  of  the  immediate  effects  of  which 
are  pallid  countenance,  frontal  headache,  puny,  un- 
healthy looks,  defective  digestion,  susceptibility  to 
disease,  feeble  power  of  recuperating  from  illness, 


EDUCATION.  105 

and  a  fretful,  irritable  disposition.  If  the  life  of 
the  child  be  spared,  the  future  is  liable  to  be  blight- 
ed by  a  general  want  of  strength,  and  by  disorders 
caused  by  a  defective  nerve-force. 

If  any  of  the  symptoms  enumerated  appear 
while  the  child  is  attending  school,  it  should  be 
ascertained  whether  the  hours  for  sleep  and  exercise 
are  not  drawn  upon  for  study,  and,  if  this  be  the 
case,  the  number  of  studies  should  be  at  once  re- 
duced, or  the  child  should  be  taken  away  from 
school  for  a  time. 

In  seeking  the  cause  of  the  loss  of  vitality,  par- 
ents must  be  just  in  their  analysis  of  the  child's 
habits.  The  tendency  to  place  the  onus  upon  over- 
study  is  very  great,  for  unquestionably  over-mental 
application  is  very  often  the  cause ;  more  frequently, 
however,  the  failure  in  health  is  the  result  of  a  non- 
observance  of  hygienic  laws.  A  child  between  ten 
and  fifteen  years  of  age,  who  takes  a  sufficient  quan- 
tity of  good  nourishment,  is  properly  clad,  breathes 
a  pure  atmosphere,  is  compelled  to  take  several 
hours'  recreation  daily,  who  secures  from  eight  to 
ten  hours'  sound  sleep  every  night,  and  is  kept  free 
from  the  excitement  of  theatres,  concerts,  and  par- 
ties, runs  little  risk  from  mental  application. 

Care  must  be  taken  that  a  child  is  not  sent 


106  HYGIENE  OF  CHILDHOOD. 

back  to  school  too  soon  after  having  been  ill  with 
typhoid  fever,  scarlet  fever,  diphtheria,  pneumonia, 
or  other  diseases  where  there  have  been  serious  con- 
stitutional disturbances.'  This  care  should  be  more 
particularly  observed  with  girls  from  the  age  of 
twelve  to  fifteen — during  the  years  of  puberty. 
Too  early  return  to  school  duties  after  a  serious  ill- 
ness at  this  age,  especially  after  typhoid  fever,  fre- 
quently will  arrest  the  growth,  and  induce  a  delicacy 
which  may  take  years  to  eradicate.  The  period  of 
convalescence  should  be  prolonged  as  much  as  pos- 
sible, to  enable  the  nervous  system,  which  is  always 
exhausted  by  prolonged  fever,  to  thoroughly  recu- 
perate or  regain  the  force  lost  during  the  illness. 

SCHOOL  HYGIENE. 

The  importance  of  school  hygiene  is  too  often 
overlooked  by  parents  in  their  selection  of  a  school. 
By  school  hygiene  is  meant  the  purity  of  the  school- 
room air,  its  warmth,  its  cleanliness,  its  light,  the  san- 
itary surrounding  of  the  play-ground,  the  duration 
of  school  hours  and  recess,  and  the  suitability  of 
the  chairs  and  desks  to  the  requirements  of  each 
child. 

The  imperfect  observance  of  these  hygienic  ne- 


SCHOOL  HYGIENE.  107 

cessities  frequently  occasions  the  headache,  the  loss 
of  appetite,  the  languor,  the  disinclination  for  walk- 
ing and  exercise  that  many  children  experience  on 
returning  home  from  school.  "When  the  school- 

o 

room  is  well  lighted,  the  air  pure  and  not  over- 
heated, the  habit  of  attention  and  power  of  applica- 
tion are  very  greatly  increased. 

We  have  already  explained  the  evils  resulting 
from  foul  air  in  the  house ;  the  same  results  natu- 
rally follow  the  breathing  of  foul  school-room  air, 
where  its  effects  bring  also  demerits  to  the  child, 
by  blunting  his  intellectual  faculties.  [Restlessness 
and  forgetfulness,  often  the  result  of  foul  air,  are 
punished  by  the  extra  hour  of  detention  after  the 
school  hour  proper.  This  additional  strain,  added 
to  the  loss  of  dinner — for  by  this  time  the  appetite 
is  usually  destroyed — reacts  upon  the  child,  bringing 
on  the  morrow  an  increasing  dullness. 

A  wholesome  and  tempting  lunch  should  be  pre- 
pared, and  the  child  should  be  given  to  understand 
that  he  must  eat  it,  for  continued  mental  work  is 
more  or  less  exhausting,  and  Xature  calls  for  a  res- 
toration of  the  tissues  used  up  or  destroyed  by  exer- 
cise. 

The  desks  and  chairs  should  be  so  constructed 
that  the  book  on  the  desk  is  not  brought  too  near 


108  HYGIENE  OF  CHILDHOOD. 

the  eyes  of  the  scholar,  nor  should  it  be  so  low  as  to 
allow  the  child  to  bend  the  back  while  studying. 

The  instructors  should  have  such  knowledge  of 
physiology  and  personal  hygiene  that  they  may  in- 
telligently enforce  the  laws  of  health  so  far  as  they 
relate  to  school-life.  If  this  necessary  knowledge 
were  required  of  all  teachers,  there  would  be  an  in- 
crease in  the  average  intelligence  of  the  pupils, 
fewer  absentees  from  school  on  account  of  illness ; 
and  rounded  shoulders  and  crooked  spines,  the  re- 
sult of  faulty  positions  at  the  school-desk,  would  be 
less  frequently  met  with. 

DISCIPLINE. 

To  enable  a  parent  to  carry  out  effectually  the 
regulations  necessary  for  the  healthy  growth  of  a 
child,  it  is  essential  that  the  child  should  be  taught 
obedience  and  self-control.  Lessons  in  obedience 
can  be  and  should  be  commenced  during  the  early 
months  of  infancy ;  for  children,  like  animals,  will 
intuitively  recognize  the  necessity  of  obedience  and 
the  authority  and  right  to  be  commanded  when  the 
commands  are  given  in  a  kindly  yet  positive  manner. 
"When  children  rule  their  parents  in  matters  of  eat- 
ing or  dressing,  or  in  any  equally  important  duty  of 
life,  there  is  less  likelihood  that  the  principles  neces- 


DISCIPLINE.  109 

rary  for  the  maintenance  of  health  will  be  fully  en- 
forced ;  so  that  in  the  hygiene  of  childhood,  the 
mainspring  is  discipline  in  obedience  and  self-con- 
trol. When  this  discipline  is  not  enforced,  when 
children  are  allowed  to  carry  out  their  own  ideas,  to 
gratify  their  own  wishes,  and  are  not  taught  defer- 
ence for  the  authority  and  opinion  of  their  elders, 
they  are  apt  to  grow  up  selfish,  and  to  exert  an  un- 
pleasant influence  upon  those  about  them. 

Unfortunately,  many  parents  have  not  the  ability 
to  teach  their  children  the  habit  of  self-control,  on 
account  of  possessing  so  little  of  it  themselves,  and 
children,  from  force  of  example,  become  self-indul- 
gent. Then,  too,  when  obedience  is  exacted,  harsh- 
ness, almost  brutality,  is  often  employed,  instead  of 
that  firm  but  kindly  insistence  which  calls  forth  a 
more  cheerful  acquiescence  upon  the  part  of  the  child. 
It  is  impossible  to  expend  too  much  effort  in  form- 
ing the  habit  of  self-control.  When  this  is  not  cul- 
tivated, the  child  becomes  a  monster  of  eelfishness, 
and  a  source  of  continual  discomfort  to  himself  and 
those  about  him;  while,  on  the  other  hand,  the  culti- 
vation of  self-control  insures  a  happier  disposition, 
which  will  win  friends  in  later  years  and  also  in- 
crease the  prospect  of  prolonged  life  and  vigorous 
health,  making  him.  a  more  evenly  balanced  man, 


HO  HYGIENE  OF  CHILDHOOD. 

and  widening  his  field  of  usefulness  in  the  commu- 
nity in  which  he  lives.  In  enforcing  obedience, 
harsh  terms  are  not  necessary.  A  child,  by  nature, 
has  an  inquiring  mind,  and  desires  to  know  the 
causes  of  everything.  While  obedient,  the  reason  of 
an  order  will  frequently  be  asked;  this  should  be 
gratified  when  feasible.  At  the  same  time,  the  child 
should  be  taught  to  have  such  confidence  in  his 
parents  that  he  will  understand,  when  a  command  is 
given,  that  it  must  be  obeyed,  even  though  the  pur- 
port is  not  understood.  Whenever  it  is  proper  to 
give  the  reason  for  a  request,  it  is  well  to  do  so, 
for  a  child's  ideas  are  thus  educated,  a  habit  of 
reasoning  is  developed,  which  is  always  important 
for  the  young  mind,  while  at  the  same  time  it  fos- 
ters a  closer  relationship  between  the  parent  and 
child. 

The  physician,  on  his  round  of  visits  among  the 
sick,  is  only  too  familiar  with  the  unfortunate,  often 
disastrous  results  of  want  of  self-control.  How  fre- 
quently the  reply,  when  the  doctor  prescribes  a 
certain  diet  or  a  certain  mode  of  exercise,  "  Well, 
doctor,  the  child  would  have  it,"  or  "  The  child  ob- 
jected to  doing  as  you  said  "  !  The  little  tyrant 
must  be  obeyed ;  the  parents  must  comply  with  his 
wishes,  even  though  the  judgment  decides  against  it. 


HYGIENIC  REFLECTIONS.  HI 

With  such  children  and  parents  the  laws  of  health 
can  not  be  judiciously  followed.  The  child  that 
makes  free  use  of  the  words  "shall,"  "won't," 
"  sha'n't,"  or  "  will "  has  a  diminished  chance  of  re- 
covering from  serious  illness. 

These  demonstrations  of  self-will  are  not  so  much 
the  results  of  rebellion  and  temper  as  they  are  of 
faulty  management  during  the  early  years  of  life 
upon  the  part  of  the  parent.  Recognizing  the  fact 
that  children's  dispositions  differ  in  many  cases,  the 
seeming  irritablity  may  often  be  overcome  by  firm- 
ness, kindness,  and  explanation.  It  should  not  be  for- 
gotten, however,  that  the  irritability  of  many  chil- 
dren, and  their  disobedience,  which  is  frequently  de- 
pendent upon  a  condition  of  irritation,  are  also  occa- 
sionally the  results  of  impaired  health.  We  see, 
then,  how  defective  physical  condition  in  a  child 
disturbs  calmness  of  disposition,  and  how  the  ab- 
sence of  self-control  affects  the  physical  health. 

HYGIENIC  REFLECTIONS. 

During  childhood  the  seeds  of  future  health, 
vigor,  and,  I  might  add,  happiness,  are  sown.  "  As 
we  sow,  so  shall  we  reap."  As  Dr.  Erasmus  Wilson 
has  very  fitly  remarked :  "  Youth,  it  can  not  be  too 


112  HYGIENE  OF  CHILDHOOD. 

often  repeated,  is  the  time  for  storing  health,  both 
physical  and  moral ;  and  every  act  which  can  in  any 
way  impede  or  frustrate  this  all-wise  intention  of 
Nature  will  tend  to  lay  the  foundation  of  a  weak 
and  imperfect  body,  and  shorten  the  days  of  its  pos- 
sessor." The  laws  of  health  are  as  fixed  as  other 
physical  laws,  and  any  infringement  of  them  is  cer- 
tain to  be  followed  by  evil  results ;  so  that  if  the 
body  is  not  properly  clad,  if  there  is  insufficient  or 
improper  nourishment,  a  deprivation  of  sleep,  exer- 
cise, pure  air,  or  sunshine,  if  the  brain  is  overtaxed 
with  studies,  or  if  any  of  the  laws  governing  health 
are  violated  during  childhood,  a  penalty  will  be  ex- 
acted— if  not  during  the  period  of  youth,  certainly 
later  in  life. 

Herbert  Spencer  says  of  children  :  "  To  tens  of 
thousands  that  are  killed,  add  hundreds  of  thousands 
that  survive  with  feeble  constitutions,  and  millions 
that  grow  up  with  constitutions  not  so  strong  as 
they  should  be,  and  you  will  have  some  idea  of  the 
curse  inflicted  on  their  offspring  by  parents  igno- 
rant of  the  laws  of  health.  Do  but  consider  for  a 
moment  that  the  regimen  to  which  children  are  sub- 
ject is  hourly  telling  upon  them  to  their  life-long 
injury  or  benefit,  and  that  there  are  twenty  ways 
of  doing  wrong  to  one  way  of  doing  right,  and  you 


HYGIENIC  REFLECTIONS.  113 

will  get  some  idea  of  the  enormous  mischief  that  is 
almost  everywhere  inflicted  by  the  thoughtless,  hap- 
hazard system  in  common  use.  Is  it  decided  that 
a  boy  shall  be  clothed  in  some  flimsy  short  dress  and 
be  allowed  to  go  playing  about  with  limbs  reddened 
by  cold  ?  The  decision  will  tell  on  his  whole  future 
existence,  either  in  illnesses,  or  in  stunted  growth, 
or  in  deficient  energy,  or  in  a  maturity  less  vig- 
orous than  it  ought  to  have  been,  and  consequently 
be  a  hindrance  to  success  and  happiness !  Are  chil- 
dren doomed  to  a  monotonous  dietary,  or  a  die- 
tary that  is  deficient  in  nutritiveness  ?  Their  ulti- 
mate physical  power  and  efficiency  as  men  and  wom- 
en will  inevitably  be  more  or  less  diminished  by 
it.  When  sons  and  daughters  grow  up  sickly  and 
feeble,  parents  commonly  regard  the  event  as  a  mis- 
fortune, as  a  visitation  of  Providence.  Thinking 
after  the  prevalent  chaotic  fashion,  they  assume  that 
these  evils  come  without  causes,  or  that  the  causes 
are  supernatural.  Nothing  of  the  kind !  In  some 
cases  the  causes  are  doubtlessly  inherited ;  but  in 
most  cases  foolish  regulations  are  the  causes.  Very 
generally  parents  themselves  are  responsible  for  all 
this  pain,  this  debility,  this  depression,  this  misery. 
They  have  undertaken  to  control  the  lives  of  their 
offspring  from  hour  to  hour ;  with  cruel  carelessness 


114  HYGIENE  OF  CHILDHOOD. 

they  have  neglected  to  learn  anything  about  those 
vital  processes,  which  they  are  unceasingly  affecting 
by  their  commands  and  prohibitions ;  in  utter  igno- 
rance of  the  simplest  physiological  laws,  they  have 
been  year  by  year  undermining  the  constitutions  of 
their  children,  and  have  so  inflicted  disease  and  pre- 
mature death  not  only  on  them,  but  on  their  descend- 
ants." 

If  a  child  manifests  any  bodily  weakness  that  is 
not  hereditary  or  that  has  not  followed  some  acute 
illness,  parents  should  ask  themselves  the  question, 
Which  of  the  laws  of  health  has  been  violated  ?  If 
careful  scrutiny  is  given,  it  will  be  found  that  the 
impaired  health  has  been  induced  by  one  or  more  of 
the  following  causes :  Insufficient  or  improper  nour- 
ishment, irregular  or  too  hasty  eating,  whereby  the 
functions  of  digestion  are  disturbed,  and  the  power 
of  assimilation  of  food  impaired ;  drinking  impure 
water,  a  prolific  cause  of  lowering  the  tone  of  the 
system  and  bringing  about  mal-digestion  ;  breathing 
impure  air ;  insufficient  sunlight ;  insufficient  exer- 
cise in  the  open  air ;  insufficient  protection  of  the 
surface  of  the  body,  the  non-wearing  of  flannels  by 
night  as  well  as  by  day  during  the  winter  months  ; 
insufficient  sleep  and  repose ;  neglecting  the  daily 
action  of  the  bowels  and  care  of  the  skin  ;  overtax- 


PUBERTY.  115 

ing  the  nerve- force  by  too  much  memorizing  and 
overstudj. 

The  symptoms  indicating  a  lowered  vitality  often 
come  on  so  insidiously  that  they  are  overlooked  by 
the  parent  until  the  health  is  seriously  undermined. 
These  symptoms  may  be  briefly  stated  as  follows :  A 
change  in  the  general  demeanor,  a  depression  with 
loss  of  the  usual  brightness  and  vivacity,  often  dull- 
ness and  languor,  or  irritability,  when  the  child  is 
said  to  be  "  cross,"  sleeplessness,  or  a  disturbed,  rest- 
less sleep,  frequently  a  tendency  to  fall  asleep  during 
the  daytime,  loss  of  flesh,  pallid  countenance,  and 
disinclination  to  take  the  accustomed  exercise. 

Many  hereditary  physical  tendencies  may  be  over- 
come by  special  attention  to  the  child's  personal  hy- 
giene. 

PUBERTY. 

My  remarks  on  the  preceding  pages  apply  alike 
to  the  boy  and  girl.  I  now  desire  to  call  special  at- 
tention to  the  hygiene  of  the  girl,  during  that  pe- 
riod of  transition  from  girlhood  to  womanhood, 
termed  puberty,  a  time  when  too  often,  through  neg- 
lect, the  seeds  of  future  ill  health  are  sown. 

A  case  in  point  will  serve  as  a  text  for  this  im- 
portant subject.  I  was  once  called  to  see  a  young 
girl  of  about  fourteen  years  of  age,  who,  from  a  state 


116  HYGIENE  OF  CHILDHOOD. 

of  apparent  health,  was  suddenly  prostrated  while  at 
a  child's  party.  She  was  taken  home  and  remained 
in  a  condition  of  exhaustion  for  several  weeks'.  Pos- 
sessing an  active  temperament,  she  had  always  been 
quick  and  eager  to  learn.  Her  studies  had  been  con- 
tinued without  intermission,  save  for  a  few  school 
holidays,  summer  and  winter,  during  the  period  of 
two  years.  This  unnatural  strain  gave  the  system 
no  rest,  it  burned  up  the  nerve-force  as  rapidly  as  it 
was  created.  The  overheated  room  at  the  entertain- 
ment had  a  depressing  effect  upon  her,  snapped  the 
tension  to  which  the  nervous  system  had  been  sub- 
jected, and  induced  a  condition  of  physical  and 
nerve  exhaustion.  This  depression  was  character- 
ized by  great  feebleness  of  the  digestive  organs,  a 
condition  of  torpidity,  irregular  heart-action,  head- 
ache, great  lassitude,  but  no  fever.  She  remained  in 
this  condition  for  several  weeks,  gradually  recover- 
ing her  strength,  but  showing  for  many  subsequent 
months  an  appearance  of  weariness  in  her  counte- 
nance. It  was  necessary  to  abandon  her  studies  for 
more  than  a  year ;  and  for  several  months  after  they 
were  resumed,  only  light  mental  work  was  possible. 
The  early  history  of  this  young  girl  is  but  a  rep- 
etition of  many  others  which  are  constantly  brought 
to  the  notice  of  physicians,  where  the  education  of 


PUBERTY. 

the  mind  is  at  the  expense  of  the  body  ;  where,  at  the 
period  of  life  when  the  nervous  structure  is  develop- 
ing, when  the  reproductive  organs  are  taking  on 
new  changes,  the  nerve-force  is  exhausted  by  over- 
stimulation  of  the  brain  and  does  not  obtain  suffi- 
cient rest. 

The  question  is  often  asked,  Why  is  it  that 
young  children  and  girls  of  the  present  time  can  not 
dress  and  do  as  did  their  mothers  and  grandmothers 
at  their  age  ?  Excepting  when  there  is  hereditary 
delicacy,  girls  of  the  present  generation  will  be  found 
just  as  robust  and  just  as  capable  of  enduring  strong 
physical  exercise  as  their  grandmothers  were,  always 
providing  that  their  lives  are  adjusted  in  conform- 
ity with  the  laws  governing  health.  Degenerated 
health  is  in  most  cases  the  result  of  exhausted  nerve 
energy,  improper  diet,  and  an  inactive,  indoor  life. 

Let  us  contrast  for  a  moment  the  life  of  the  pres- 
ent generation  with  that  of  three  generations  ago. 
Our  grandparents  were,  in  a  measure,  "  the  survival 
of  the  fittest."  Their  manner  of  living  was  such 
that  the  majority  of  delicate  offspring  perished  in 
early  life ;  and  those  who  survived,  and  whose  consti- 
tutions withstood  the  strain,  were  the  possessors  of  a 
vigorous  physique.  Mothers  must  disabuse  their 
minds  of  the  common  error  that  because  they  and 


118  HYGIENE  OF  CHILDHOOD. 

their  mothers  dressed,  or  rather  undressed,  in  accord- 
ance with  the  fashion  of  their  day,  they  may  continue 
to  clothe  their  children  in  the  same  way.  In  cases 
where  bare  legs,  arms,  and  neck  were  adopted,  evil 
results  must  have  followed,  and  fallen,  if  not  upon 
the  individual  herself,  certainly  upon  her  offspring, 
for  the  laws  governing  health  were  the  same  then  as 
they  are  now.  Those  who  are  vigorous  and  strong 
can  resist  an  evil  influence  longer  than  those  who 
are  weak. 

We  at  present  live  in  an  essentially  fast  age. 
Our  parents  and  grandparents  lived  a  quieter  life. 
There  was  then  an  absence  of  many  of  the  excite- 
ments which  call  into  action  the  nerve-force  of  the 
present  generation.  The  rush  and  excitement  that 
our  every-day  life  call  for,  did  not  exist  three  quar- 
ters of  a  century  ago,  and  consequently  the  tax  upon 
the  mind,  and  the  wear  and  tear  on  the  nerve-force, 
of  both  young  and  old,  were  not  so  great  then  as  now. 
The  home  life  of  the  present  generation  is,  as  a  rule, 
full  of  ceaseless  activity.  The  sensational  events  that 
the  newspapers  recount,  reach  the  various  homes,  are 
too  often  discussed  before  children,  and  can  not  but 
have  a  stimulating  effect  upon  their  brains.  The 
school-books  of  to-day,  although  in  many  respects 
most  suitable,  call  for  an  amount  of  close  applica- 


PUBERTY.  119 

tion  and  an  exercise  of  thought  that  were  not  re- 
quired of  our  grandparents. 

The  life  of  a  century  ago  was  comparatively  a 
quieter  one  and  less  conducive  to  nerve  exhaustion. 
Books  were  of  a  less  stimulating  character;  the  daily 
papers  did  not  introduce  into  the  family  circle  topics 
of  such  an  exciting  nature ;  there  was  an  absence  of 
the  hurry  and  rush  of  modern  travel  and  business. 
In  other  words,  the  life  of  to-day  is  productive  of 
nerve  excitability,  to  be  followed  by  exhaustion, 
while  the  life  of  olden  days  was  more  favorable  to 
nerve  rest. 

This  comparison  of  the  life  of  our  grandparents 
with  the  life  of  the  present  generation  is  brought 
forward  to  show  that  in  this  era  there  is  an  increased 
call  for  nerve  energy  and  the  greatest  danger  of  ex- 
hausted nerve-force,  and  emphasizes  the  importance 
for  mothers  and  guardians  of  the  young,  to  watch 
and  guard  carefully  the  nervous  and  physical  condi- 
tion of  young  girls  as  they  bloom  into  womanhood. 

The  good  book  says  that  the  sins  of  the  fathers 
shall  be  visited  upon  the  children  unto  the  third  and 
fourth  generation.  This  is  perfectly  true  of  physi- 
cal as  well  as  of  moral  sins.  How  often  do  we 
see  handsome,  stately  mothers  and  grandmothers  of 
seventy  or  eighty  years  af  age,  with  clear  eyes,  fine 


120  HYGIENE  OF  CHILDHOOD. 

complexion,  erect  carriage,  and  every  appearance  ol 
good  health,  surrounded  by  children  and  grandchil- 
dren of  delicate  constitutions !  This  feebleness  is  not 
entirely  due  to  the  follies  of  the  present  manner  of 
living,  but  may  be  largely  due  to  the  erroneous  life  of 
the  mother  or  grandmother,  who  as  "  survival  of  the 
fittest "  apparently  grew  physically  and  mentally  to 
perfection,  yet  her  fruit  suffered  from  the  result  of 
her  indiscretion.  If  this  truth  is  fully  recognized 
and  borne  in  mind  during  the  period  of  a  young 
girl's  development,  there  will  be  a  distinct  gain,  not 
only  to  her  in  the  possession  of  a  healthy  body  and 
mind,  but  also  to  her  future  offspring.  A  tree  in 
the  orchard  may  recover  from  the  shock  of  a  cold 
spring,  be  rich  in  foliage  and  have  a  stately  appear- 
ance during  the  summer,  yet  not  be  so  productive  in 
the  quantity  and  quality  of  its  fruit  as  a  tree  that 
has  had  no  shock. 

Aside  from  the  suggestions  already  given  for  the 
care  of  children,  there  are  a  few  fundamental  rules 
to  be  observed  by  young  girls  at  this  time,  the  neg- 
lect of  which  only  too  frequently  inflicts  pain  and 
suffering  on  body  and  mind  in  after-years.  As  the 
young  girl  approaches  this  time  of  life,  a  change 
is  noticed  in  her  demeanor  and  general  habits. 
There  is  frequently  a  derangement  of  digestion ;  the 


PUBERTY.  121 

appetite  is  capricious  and  morbid ;  there  may  be  de- 
pression of  spirits,  languor,  a  certain  amount  of  men- 
tal inactivity,  and  at  times  a  restlessness  and  irrita- 
bility of  an  hysterical  nature.  The  child's  mind 
should  be  prepared  for  the  coming  change.  The 
mother  should,  by  a  few  judicious  words,  put  clearly 
before  her  daughter  the  nature  of  the  coming  event, 
and  explain  the  necessity  of  careful  obedience  to  the 
rules  given  her  for  the  care  of  her  health  at  this 
time.  The  great  change  that  is  going  on  in  the 
system  produces  a  disturbance  in  the  circulation ; 
this  affects  the  appetite,  and  occasions  the  symptoms 
above  mentioned.  Disturbances  of  all  kinds  should 
be  promptly  investigated  and  relieved,  in  order  that 
the  child  may  be  kept  as  nearly  as  possible  in  a  per- 
fect state  of  health,  and  that  all  stumbling-blocks 
may  be  removed  from  Nature's  way  in  this  crisis  she 
is  bringing  about.  The  digestion  should  be  kept  in 
perfect  order,  the  bowels  regular,  and  morbid  crav- 
ings should  not  be  indulged.  Food  should  be  of  a 
simple,  non-stimulating  character.  If  there  is  any 
languor  or  debility,  it  should  be  met  by  tonics, 
plenty  of  fresh  air,  and  good  food.  The  depression 
of  spirits  or  irritability  may  be  relieved  by  regulat- 
ing the  digestion,  by  tonics,  by  release  from  all  men- 
tal work,  and  by  the  society  of  cheerful  companions. 


122  HYGIENE  OF  CHILDHOOD. 

I  have  called  attention  to  the  importance  of  pro- 
tecting the  body  from  cold ;  the  directions  given  ap- 
ply now  with  double  force.  In  the  climate  in  which 
we  live  it  is  absolutely  necessary  that  the  body  of 
every  individual  should,  in  winter,  be  protected  by 
flannel  or  silk  worn  next  to  the  skin.  When  this  is 
neglected,  there  is  a  great  waste  of  nerve-force  in 
Nature's  effort  to  maintain  the  proper  standard  of 
animal  heat.  Extreme  care  should  be  paid  to  the  pro- 
tection of  the  feet.  The  reader  is  doubtless  aware 
of  the  disastrous  effect  of  a  cold  foot-bath  during 
the  monthly  period ;  a  severe  congestion  takes  place 
in  the  pelvic  region,  followed  frequently  by  inflam- 
mation and  death.  When  the  feet  are  constantly 
bathed  in  cold  air,  as  they  are  when  slippers  are  worn 
in  the  house  in  cold  weather,  and  thin  shoes  in  the 
street  in  winter,  we  have  resulting  more  or  less  con- 
gestion, or  oversupply  of  blood  to  the  pelvic  organs. 
Oftentimes  this  congestion  is  so  slight  that  its  pres- 
ence is  not  apparent.  If,  however,  it  is  maintained 
for  any  length  of  time,  structural  changes  take  place, 
and  create  the  pain  and  distress  that  so  many  girls 
and  women  undergo.  If  any  one  organ  of  the 
body  is  already  in  a  state  of  congestion,  this  conges- 
tion will  be  increased  by  cold  to  the  extremities, 
We  now  see  the  importance  of  protecting  the  feet 


PUBERTY.  123 

and  legs  of  the  young  girl  when  this  change  in  her 
system  is  taking  place.  At  this  time  the  pelvic  or- 
gans are  in  a  condition  of  increased  nervous  irritabil- 
ity, a  natural,  healthy  state  of  congestion  ;  but  if  we 
have  thrown  upon  them  an  abnormal  congestion, 
disease  is  the  result.  Therefore,  one  of  the  first  rules 
for  young  girls,  and  I  should  add  women  also,  to  ob- 
serve, is  to  protect  the  feet,  not  only  during  the  men- 
strual period  but  at  all  times.  When  the  physician 
urges  the  necessity  of  flannels  being  worn  next  the 
skin,  both  undershirt  and  drawers,  and  of  protecting 
the  feet  by  warm  boots,  and  the  avoidance  of  slip- 
pers in  winter,  many  will  use  the  argument  that  they 
are  well  and  strong,  and  point  to  others  who  are  also 
strong  notwithstanding  improper  dressing.  This  is 
very  poor  reasoning :  one  may  not  realize  the  conse- 
quence of  a  wrong  deed,  but  that  does  not  make  the 
deed  right.  Many  who  are  insufficiently  clad  may 
say  that  they  do  not  feel  cold.  This  may  be  true, 
for  the  surface  of  the  body  and  feet  may  cease  to  be 
conscious  of  cold,  from  habitual  exposure,  just  as  we 
cease  to  be  conscious  that  our  faces  are  cold,  even 
when  out-of-doors ;  but,  because  the  sensation  of  cold 
no  longer  warns  us,  it  does  not  follow  that  the  sys- 
tem escapes  injury.  Thousands  and  tens  of  thou- 
sands die  in  their  effort  to  follow  the  example 


124  HYGIENE  OF  CHILDHOOD. 

of  those  foolhardy  people  who  defy  the  laws  of 
Nature. 

Another  important  matter  to  observe  at  this 
time  is  the  avoidance  of  too  great  mental  strain.  It 
must  be  remembered  that  the  nervous  system  is 
called  upon  to  perform  a  new  duty ;  extra  work  is 
required  of  it,  and  one  must  be  watchful  that  it  is 
not  overburdened.  For  several  months  before  the 
establishment  of  menstruation,  and  during  the  first 
year  of  the  change,  school  duties  should  be  very 
light  and  at  times  omitted,  if  any  symptoms  indi- 
cating marked  nerve  disturbance  supervene.  This 
nerve  disturbance  is  shown  by  restlessness  or  head- 
ache, excitability,  irritability  of  temper,  or  by  an 
hysterical  condition,  when  the  young  girl  cries  with- 
out cause,  or  from  a  cause  which,  at  other  times, 
would  have  no  effect  upon  her.  If  there  are  pallor 
of  countenance,  weariness,  and  loss  of  appetite 
which  is  not  improved  by  tonics,  school  duties 
should  be  omitted  for  a  time,  and  exercise  in  the 
fresh  air  substituted. 

Sleep  is  one  of  Nature's  greatest  restorers ;  par- 
ents can  not  be  too  particular,  therefore,  that  at  this 
time  especially  the  young  girl  obtains  her  full  amount 
of  sleep  for  nine  or  ten  hours.  The  disastrous  ef- 
fects of  overtaxing  the  brain  at  this  time  of  develop- 


PUBERTY.  125 

ment,  often  follow  one  through  the  remaining  years 
of  life ;  the  periodical  sick  headache,  to  which  so 
many  women  are  martyrs,  is,  in  many  instances, 
entirely  the  result  of  an  overtaxed  brain  at  the  time 
of  puberty.  The  nervous  system  of  a  girl  is  more 
highly  organized,  more  sensitive  to  impressions,  and 
therefore  needs  more  rest  and  protection,  than  that 
of  a  boy.  Her  organs  of  generation  require  the  full 
amount  of  nerve-nutrition  for  their  perfect  devel- 
opment. When  the  nerve-force  is  diverted  by  too 
great  mental  strain,  or  by  repeated  shocks  to  the 
system  from  cold,  as  the  result  of  scanty  clothing, 
an  arrested  development  of  the  ovaries  and  uterus 
is  very  apt  to  occur,  and  after  marriage  there  is  a 
strong  likelihood  of  a  childless  home. 

Mental  work  should  be  relaxed,  and  in  many 
cases  entirely  given  up,  during  the  few  days  of  men- 
strual activity.  "  Mature  has  reserved  the  catame- 
nial  week  for  the  process  of  ovulation,  and  for  the 
development  and  perfection  of  the  reproductive  sys- 
tem. Previous  to  the  age  of  eighteen  or  twenty, 
opportunity  must  be  periodically  allowed  for  the 
accomplishment  of  this  task.  Both  muscular  and 
brain  labor  must  be  remitted  enough  to  yield  suf- 
ficient forces  for  the  work.  If  the  reproductive 
machinery  is  not  manufactured  then,  it  will  not  be 


126  HYGIENE  OF  CHILDHOOD. 

later.  If  it  is  imperfectly  made  then,  it  can  only  be 
patched  up,  not  be  made  perfect,  afterward.  To  be 
well  made  it  must  be  carefully  managed."  * 

It  is  impossible  to  prescribe  the  amount  of  study 
that  a  young  girl  may  safely  undergo.  We  must 
base  our  determination  of  this  question  of  mental 
work  upon  certain  tangible  facts  or  conditions.  If 
there  is  any  impairment  of  the  general  health  or  any 
irregularity  of  the  menstrual  functions,  the  amount 
of  study  should  be  curtailed,  or  interdicted  alto- 
gether. 

If  there  is  a  hysterical  or  emotional  tendency,  it 
is  an  indication  of  a  marked  lowering  of  the  nerve- 
force  and  an  unbalanced  nervous  system.  The  girl 
should  be  taken  from  school;  and  exercise  in  the 
open  air,  with  early  hours  for  going  to  bed,  should 
be  ordered.  If  this  emotional  or  hysterical  condi- 
tion is  not  promptly  checked  during  the  years  of 
puberty,  it  will  be  fostered  and  will  grow  as  the 
burden  of  school  duties  increases,  and  in  all  proba- 
bility result  in  a  complete  collapse  of  health  after 
leaving  school  or  after  marriage. 

There  is  a  phrase,  common  in  some  families,  that 
is  calculated  to  mislead  and  do  great  harm  by  the 
careless  and  apologetic  manner  with  which  it  is 

*  "Sex  in  Education,"  by  Edward  IL  Clark,  51.  D.,  p.  41. 


PUBERTY.  127 

uttered.  The  daughter  is  said  to  be  "  so  nervous  " 
that  "  she  can  not  be  thwarted  in  her  wishes." 
"  Nervousness,"  which  should  rather  read  "  nerve- 
lessness,"  is  synonymous  with  irritability,  and  is  a 
condition  that  should  warn  mothers  of  impending 
danger.  The  nerves  are  crying  out  that  their  power 
of  resistance  has  departed.  A  state  of  nervousness 
is  not  natural  to  any  girl,  and,  where  it  exists,  it  is  a 
sure  indication  either  that  the  nervous  system  has 
been  overtaxed  in  some  way,  or  that  it  is  being  irri- 
tated by  some  morbid  condition,  or  that  the  body  is 
not  supplied  with  blood  rich  enough  to  furnish  suf- 
ficient nourishment  to  the  nervous  system.  This 
state  of  nerve-irritability  should  not  be  met  with  the 
amount  of  condemnation  that  it  so  often  receives, 
but  should  be  carefully  studied;  the  cause,  when 
found,  removed  without  delay,  and  every  aid  to  the 
re-establishment  of  health  should  be  afforded. 

In  the  management  of  girls  of  an  hysterical  or 
nervous  temperament,  a  seemingly  undue  attention 
should  be  carefully  avoided,  lest  it  should  arouse  a 
craving  for  sympathy  which  leads  to  a  condition  of 
quasi-iuv&lidism.  The  two  extremes — that  is,  one  of 
neglect  or  one  of  exaggerated  care — are  constantly 
met  with,  and  both  are  equally  reprehensible. 

I  have  already  explained  the  systemic  disturb- 


128  HYGIENE  OF  CHILDHOOD. 

ance  arising  when  there  is  not  a  daily  action  from 
the  bowels.  During  puberty,  the  evil  resulting  from 
failure  to  form  this  habit  is  very  great,  for  we  have, 
in  addition  to  the  systemic  disturbance,  a  pressure 
upon  the  blood-vessels  and  nerves  in  the  pelvic  re- 
gions, which  interferes  with  the  circulation  and  with 
the  healthy  growth  of  the  tissues  in  these  parts,  and 
is  often  the  direct  cause  of  pain  and  distress  at  the 
monthly  period. 

Dr.  Thomas  Addis  Emmet,  in  speaking  of  young 
girls  during  puberty,  says :  "  To  enable  her  to  reach 
the  highest  physical  development,  the  young  girl, 
in  the  better  ckss  of  society,  should  pass  the  year 
before  puberty,  and  some  two  years  afterward,  free 
from  all  exciting  influences.  She  should  be  a  child 
as  long  as  possible,  and  made  to  associate  with  chil- 
dren. Her  dress,  diet,  and  habits  of  life  should  be 
carefully  looked  after,  as  if  she  were  a  child,  and, 
above  all,  the  habit  of  regularity  should  be  enforced 
in  all  details.  Her  mind  should  be  occupied  by  a 
very  moderate  amount  of  study,  with  frequent  in- 
tervals during  school  hours  of  a  few  moments  each, 
and  to  be  spent,  when  possible,  in  the  open  air. 
There  should  be  no  studying  at  night  under  any  cir- 
cumstances. Each  menstrual  period  should  be  passed 
in  the  recumbent  posture,  until  the  system  becomes 


PUBERTY.  129 

accustomed  to  the  new  order  of  things,  and  the  habit 
of  regularity  is  fully  established.  She  should  neither 
expose  herself  to  cold  nor  overexercise  during  the 
twenty-four  hours  before  the  expected  period,  and 
at  the  same  time  lessons  should  be  discontinued."  * 

During  the  later  years  of  girlhood,  as  near  an 
approach  as  is  possible  to  mental  and  physical  rest 
should  be  observed  during  the  few  days  of  indispo- 
sition each  month.  Long  walks,  running  rapidly  up 
and  down  stairs,  dancing,  skating,  too  prolonged 
standing,  practicing  on  the  piano,  or  any  strong 
physical  exercise,  should  be  forbidden,  and  severe 
mental  strain  should  be  avoided.  The  want  of  suffi- 
cient rest  during  these  few  days  is  a  prolific  cause 
of  the  pelvic  pains  which  are  so  prevalent  among 
young  women.  Most  of  the  uterine  disorders  that 
young  girls  are  troubled  with  are  induced  by  per- 
sonal neglect  during  the  catamenia.  The  beginning 
of  trouble  may  frequently  be  traced  to  a  long  walk, 
or  skating,  dancing,  or  wetting  the  feet  at  the  men- 
strual period.  This  overexercise  and  cold  to  the 
feet  transform  a  naturally  healthy  congestion  of  the 
pelvic  organs  into  a  morbid  congestion,  which  re- 
mains after  the  few  days  of  functional  activity  is 
over,  and  is  the  beginning  of  the  suffering  and  de- 

*  "Principles  and  Practice  of  Gynaecology,"  p.  21. 
9 


130  HYGIENE  OF  CHILDHOOD. 

rangeraent  that  affect,  through  reflex  influence,  the 
healthy  working  of  other  parts  of  the  body. 

Although  due  care  regarding  sponging  and  bath- 
ing the  body  during  the  catamenia  is  generally  ob- 
served, indiscretions  are  not  infrequently  met  with. 
When  a  child  has  been  accustomed  to  a  daily  cold 
bath,  the  necessity  for  omitting  it,  as  well  as  the 
full  warm  bath  at  this  time,  should  appeal  to 
every  reasonable  person.  Sponging  certain  parts 
of  the  body  with  tepid  water,  for  the  purpose  of 
cleanliness,  is  permissible,  but  even  this  should  be 
done  with  care,  and  in  a  warm  room,  for  a  chill  to 
the  skin  during  these  important  days  is  attended 
with  more  or  less  serious  consequences.  The  luxury 
and  comfort  of  a  full  bath  after  several  days'  absti- 
nence frequently  lead  to  the  taking  a  cold,  full,  or 
ocean  bath  on  the  day  immediately  following  the 
cessation  of  the  period.  This  should  never  be  per- 
mitted. At  least  thirty-six  or  forty-eight  hours 
should  elapse  before  a  full  cold  bath,  for  the  pelvic 
organs  remain  in  a  state  of  congestion  for  some  time 
after  the  cessation  of  the  menstrual  flow.  A  tepid 
or  full  warm  bath  (not  too  hot)  is  permissible  and 
gives  comfort. 

Another  cause  creating  pelvic  trouble,  aside  from 
physical  imprudences  and  wasted  nerve-force,  is 


PUBERTY.  131 

that  of  tight  lacing.  The  compression  that  a  tightly 
laced  corset  produces  about  the  waist  disturbs  the 
abdominal  and  pelvic  circulation,  crowds  the  pelvic 
organs  downward,  causes  misplacement,  and  retards 
the  recovery  from  uterine  congestion. 

"When  a  sufficient  time  has  elapsed  to  show  that 
the  catamenia  is  fully  and  regularly  established,  a 
girl  who  is  healthy  and  strong,  and  free  from  any 
suspicion  of  pelvic  difficulty,  may  pursue  her  daily 
vocations  during  the  monthly  period.  A  slight 
amount  of  walking  is  conducive  to  the  healthy  ac- 
tion of  the  liver,  to  proper  performance  of  the  digest- 
ive functions,  to  the  daily  action  of  the  bowels,  and 
to  a  free  circulation  in  the  skin ;  but  unnecessary 
standing,  heavy  lifting,  and  undue  activity  must  be 
avoided.  When  there  is  any  form  of  pelvic  trouble, 
however  slight,  rest  must  be  enforced  as  much  as 
possible. 

It  is  evident  that  nature  never  intended  that 
woman  should  be  entirely  incapacitated  for  a  period 
of  from  four  to  six  days  every  month.  But  the  physi- 
cal degeneration  that  is  brought  about  through  many 
and  constant  transgressions  of  the  laws  of  health, 
and  through  hereditary  defects,  calls  for  a  greater 
care  of  the  person  during  these  important  days. 
This  applies  more  to  girls  in  the  upper  walks  of  life ; 


132  HYGIENE  OF  CHILDHOOD. 

for  in  this  class  indolent  luxury,  and  obedience 
to  the  dictates  of  fashion,  bring  about  the  greatest 
number  of  cases  of  physical  degeneracy. 

Although  my  remarks  on  the  hygiene  of  child- 
hood are  chiefly  intended  for  the  guidance  of  very 
young  children,  and  of  girls  during  the  establish- 
ment of  catamenia,  most  of  the  suggestions  are  equal- 
ly important  and  applicable,  during  the  later  years 
of  development,  until  maturity  has  been  reached. 
As  the  young  girl  advances  in  her  "  teens "  her 
thoughts  turn  to  social  pleasures  or  to  personal 
adornments.  She  will  often  assert  and  exercise  her 
own  judgment  in  matters  pertaining  to  health,  and 
in  doing  so  will,  through  ignorance  or  vanity,  in- 
fringe upon  the  laws  of  health  and  bring  upon  her- 
self sorrow  and  suffering  during  the  years  to  come. 
This  latter  period  is  also  an  important  one,  and  re- 
quires the  same  close  attention  to  the  protection 
of  the  body,  sufficient  sleep,  exercise,  sunshine,  and 
proper  nourishment,  that  we  have  already  shown  to 
be  necessary  for  younger  girls. 

The  following  example  is  but  too  often  the  repe- 
tition of  the  life  of  many  a  young  girl  of  from  fif- 
teen to  eighteen  years  of  age  :  Her  studies  are  nu- 
merous and  difficult,  and  call  for  close  application, 
often  both  afternoon  and  evening  being  devoted  to 


PUBERTY.  -.  133 

them.  She  goes  to  bed  exhausted,  awakes  in  the 
morning  with  a  feeling  of  languor,  without  appe- 
tite, frequently  with  headache  and  nausea.  She 
can  not  eat  any  breakfast,  and  will  start  for  school 
after  taking  a  cup  of  coffee  or  tea  and,  perhaps, 
some  slight  article  of  food.  She  remains  in  school 
until  two  o'clock,  taking  during  recess  some  indi- 
gestible lunch  procured  from  the  baker,  and  returns 
home  in  the  afternoon  with  impaired  appetite,  and 
too  tired  to  take  more  than  a  short  walk.  When- 
ever it  is  noticed  that  a  young  person  eats  little  at 
breakfast,  feels  languid  in  the  morning,  and  is  too 
tired  to  take  a  brisk  walk  in  the  afternoon,  it  is  an 
indication  that  something  is  radically  wrong,  and  it 
is  highly  important  that  medical  advice  should  be 
sought.  When  this  is  obtained,  it  is  found,  in  the 
vast  majority  of  cases,  that  other  factors  besides 
studies  enter  into  the  cause  of  the  ill-health. 

Untold  mischief  results  from  the  practice  com- 
mon with  many  a  school-girl  of  hurrying  off  to 
school  either  without  breakfast  or  after  having  has- 
tily swallowed  her  food.  The  system,  deprived  of 
this  needed  support,  is  utterly  unprepared  to  meet 
the  demands  upon  its  endurance  for  four  or  five 
hours  of  steady  application.  If  every  parent  would 
establish  the  rule  that  a  child  should  not  be  permit- 


134:  HYGIENE  OF  CHILDHOOD. 

ted  to  go  to  school  in  the  morning  without  having 
leisurely  eaten  a  substantial  breakfast,  it  would  ma- 
terially add  to  the  healthf  ulness  of  the  child,  and  di- 
minish the  evil  results  of  close  application  to  study. 

The  physician  often  finds,  however,  a  difficulty 
in  enforcing  the  directions  given  for  a  proper  regi- 
men of  diet  suitable  for  a  young  girl  in  her  "  teens," 
for  the  commandment,  "  Children,  obey  your  par- 
ents," is  in  many  families  reversed,  reading,  "  Par- 
ents, obey  your  children,"  and  the  young  girl  follows 
her  own  ideas  as  to  what  and  when  she  shall  eat. 

At  this  age,  social  entertainments  are  not  infre- 
quently the  direct  cause  of  impaired  health  and 
strength.  The  too  frequent  attendance  upon  par- 
ties, sociables,  concerts,  and  the  theatre  during  school- 
days means  a  deprivation  of  a  certain  amount  of 
sleep,  extra  fatigue,  the  breathing  of  impure  air, 
and,  above  all,  the  nerve-exhaustion  from  the  excite- 
ment. School  duties  require  all  the  nerve-force 
that  can  be  spared  from  the  building  process  which 
is  still  going  on  in  the  system,  so  that  the  combina- 
tion of  undue  social  excitement  with  difficult  les- 
sons has  a  damaging  effect  upon  the  health.  A  ju- 
dicious mother  will  not  allow  this  combination,  but 
it  is  altogether  of  too  frequent  occurrence  in  many 
homes. 


PUBERTY.  135 

A  full  amount  of  sleep,  and  exercise  in  the  open 
air,  should  be  insisted  upon  during  this  important 
period  of  life,  and  great  care  should  be  observed 
that  the  hours  set  apart  for  these  essential  requi- 
sites for  health  are  not  encroached  upon  for  study 
and  social  pleasures. 

Physicians  are  constantly  consulted  by  parents 
who  say  that  their  daughters'  health  is  being  under- 
mined by  school  duties.  There  is  frequently  a  good 
deal  of  truth  in  the  statement  that  they  are  study- 
ing beyond  their  years ;  but  we  also  find,  only  too 
frequently,  that  the  mother  is  ignorant  of  the  laws 
of  health,  and  that,  through  this  ignorance,  she  is  not 
doing  her  duty  to  her  child.  She  is  often  responsi- 
ble for  her  daughter's  ill-health  by  permitting  her 
to  sit  up  too  late  at  night,  attending  parties  and 
concerts,  by  allowing  her  to  wear  thin  boots  and 
unsuitable  underclothing,  by  not  insisting  upon  suf- 
ficient nourishment,  and  by  permitting  too  much 
exercise  at  the  monthly  period.  With  careful  atten- 
tion to  personal  hygiene,  and  avoidance  of  an  excess 
of  excitement  and  of  a  too  luxurious  life,  the  mother 
will  find  that  her  daughter  will  be  capable  of  great- 
er mental  work,  and  that  the  school  duties  will  not 
so  often  be  incompatible  with  vigorous  health. 

The  culture  of  the  body  should  be  as  much  an 


136  HYGIENE  OF  CHILDHOOD. 

object  of  a  mother's  solicitude  as  that  of  the  mind. 
As  she  recognizes  the  responsibility  and  necessity 
of  cultivating  the  mental  and  moral  qualities  of  her 
daugh'ter,  so  should  she  feel  that  there  is  an  equal 
obligation  to  cultivate  a  perfect  physique.  She 
should  seek  to  inform  herself  upon  the  ways  and 
means  of  preserving  the  health  of  her  daughter,  and 
make  it  an  all-important  object — I  might  say,  a 
religious  duty — to  avoid  everything  which  may 
prove  an  obstacle  to  the  development  of  a  perfect 
woman. 

"  If  we  would  give  our  girls  a  fair  chance,  and 
see  them  become  and  do  their  best  by  reaching  after 
and  attaining  an  ideal  beauty  and  power,  which 
shall  be  a  crown  of  glory  and  a  tower  of  strength  to 
the  republic,  we  must  look  after  their  complete  de- 
velopment as  women.  Wherein  they  are  men,  they 
should  be  educated  as  men;  wherein  they  are  wo- 
men, they  should  be  educated  as  women.  The  phys- 
iological motto  is,  educate  a  man  for  manhood,  a 
woman  for  womanhood,  both  for  humanity.  In 
this  lies  the  hope  of  the  race."  * 

*  "Sex  in  Education,"  by  E.  H.  Clark,  M.  D.,  p.  19. 


APPENDIX. 


MORTUARY  STATISTICS. 

IT  may  not  be  without  interest,  as  bearing  upon 
the  subject  of  the  hygiene  of  childhood,  to  glance  at 
the  mortuary  tables  of  some  of  the  large  cities  of  the 
United  States,  and  also  to  note  the  comparative  mor- 
tality of  large  and  small  cities.  Upon  investigation 
it  will  be  found  that  during  the  past  twenty  years  a 
gradual  lowering  of  the  death-rate  among  children 
has  taken  place,  and  that  the  percentage  of  deaths  is 
noticeably  less  in  the  smaller  cities. 

In  New  York  city  in  1867  the  percentage  of 
deaths  among  children  under  five  years  of  age  to 
the  total  mortality  was  52-9  ;  while  in  1888,  twenty- 
one  years  later,  the  percentage  was  43*2,  a  lowering 
of  9.7  per  cent,  or  an  equivalent  to  saving  in  1888 
the  lives  of  3,896  children  under  five  years  of  age. 
From  1865  to  1875  the  average  mortality  under 
five  years  of  age  in  New  York  city  was  49*61 
per  cent. 


138  HYGIENE  OF  CHILDHOOD. 

Mortuary  Table  for  1873. 


LOCALITY. 

Total 
number 
of  deaths. 

Total 
number  of 
deaths  under 
five  years 
of  age. 

Percentage  of 
deaths  under 
five  years  of 
age  to  total 
mortality. 

New  York  city  

29,084 

14  182 

48'7 

Philadelphia,  Pa  

15,224 

6  '260 

42-7 

Brooklyn,  N.  Y  

10  968 

5  536 

50  '5 

Chicago,  111  

9  557 

5  676 

59'3 

St.  Louis,  Mo  

8  551 

4  014 

46'9 

Boston,  Mass  

7  869 

3  289 

41-7 

Baltimore,  Md  

7  817 

3  379 

43'2 

Average  mortality  under  five  years  of  age  for  1873,  47'4  per  cent 


Mortuary  Table  for  1888. 


LOCALITY. 

Total 
number 
of  deaths. 

Total 
number  of 
deaths  under 
five  years 
of  age. 

Percentage  of 
deaths  under 
five  years  of 
age  to  total 
mortality. 

New  York  city  

40,175 

17,360 

43-2 

Philadelphia,  Pa  

20,372 

7,268 

35-6 

Brooklyn,  N.  Y  

18,061 

8,019 

44-3 

Chicago,  111  

16,645 

7,533 

45  2 

Boston,  Mass  

10,179 

3,599 

35-2 

St.  Louis,  Mo.  .  .  

9,015 

3,659 

40-5 

Baltimore,  Md  

8,936 

3,881 

43-6 

Average  mortality  under  five  years  of  age  in  1888,  41  per  cent. 

A  comparison  of  the  average  death-rate  in  1873 
(47"t  per  cent)  with  that  of  1888  (41-0  per  cent) 
exhibits  a  reduction  of  6-4  per  cent,  or  the  saving 
of  the  lives  of  7,896  children  in  the  above-mentioned 
cities  in  1888. 


APPENDIX. 


139 


Percentage  of  Deaths  of  Children  under  Five  Tears  of  Age 
to  the  Total  Mortality  in  Seven  Cities  of  Small  Size. 

Poughkcepsic,  N.  Y.,  in  1888 32*6 

Newburgh,  N.  Y.,  in  1888 34'4 

New  Haven,  Conn.,  in  1888 34  •  1 

Hartford,  Conn.,  in  1888 27'8 

Newport,  R.  L,  in  1888 31 '4 

Lynn,  Mass.,  in  1888 33 '4 

Portland,  Me.,  in  1888 22-4 

Average  mortality  under  five  years  of  age  in  1888,  30'S  per  cent. 

Talle  of  Deaths  in  the  United  States  according  to  the 
Census. 


Total 

Percentage  of 

Total 

number  of 

deaths  under 

TEAK. 

number 

deaths  under 

five  years  of 

of  deaths. 

five  years 

age  to  total 

of  age. 

mortality. 

1870  

493,263 

203,213 

41-4 

1880  

756,893 

302,624 

39-9 

A  review  of  the  above  tables  conveys  an  instruct- 
ive and  forcible  lesson  upon  the  beneficial  observ- 
ances of  the  laws  of  health — especially  so,  when  it  is 
understood  that  the  lowering  of  the  death-rate  in  the 
large  cities  during  the  past  sixteen  years  has  been 
coincident  with  increased  interest  in  sanitation 
and  the  surveillance  on  the  part  of  local  boards  of 
health  over  the  habitations  of  the  poor  and  of  public 
buildings,  as  well  as  their  watchfulness  in  prevent- 
ing in  a  great  measure  the  sale  of  unwholesome 
food. 

The  causes  for  the  difference  in  the  death-rate  of 


140  HYGIENE  OF  CHILDHOOD. 

children,  in  large  and  small  cities,  lie  in  the  facts 
that  in  small  cities  the  inhabitants  breathe  a  purer  air, 
they  are  not  so  crowded  together,  their  food  is  of 
better  quality,  their  nervous  system  is  not  so  exhaust- 
ed from  excitement,  and  their  whole  conditions  of 
life  are  more  favorable  to  health. 

These  considerations  are  powerful  inducements 
for  still  greater  attention  to  sanitary  reform  and  the 
hygiene  of  childhood. 


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